Skip to main content
SpringerLink
Log in

Gastroösophageale Refluxkrankheit

Internationaler evidenzbasierter Konsens zur Definition der GÖRK bei Kindern und Jugendlichen

Gastroesophageal reflux disease

International evidence-based consensus on the definition of GERD in children and adolescents

  • Konsensuspapiere
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Ziel

Es sollte ein internationaler Konsensus zur Definition der gastroösophagealen Refluxkrankheit (GÖRK) in der Pädiatrie erzielt werden.

Methoden

Nach systematischer Literatursuche wurden von einer internationalen Gruppe von Kindergastroenterologen Kernaussagen entwickelt und anonym in einem modifizierten Delphi-Verfahren abgestimmt. Die Evidenzstärke orientierte sich am GRADE-System (Grading of Recommendations, Assessment, Development and Evaluation).

Ergebnisse

Konsens wurde bei 98% der 59 Kernaussagen erreicht. Wichtige Punkte sind: 1) GÖRK liegt vor, wenn Reflux von Mageninhalt belastende Symptome (Beschwerden) oder Komplikationen verursacht. Die Definition ist bei Kindern unter etwa 8 Jahren eingeschränkt, da diese nicht zuverlässig belastende Symptome angeben können. 2) Histologie dient v. a. zum Ausschluss anderer Ösophaguserkrankungen, weniger zur Sicherung der Diagnose GÖRK. 3) Barrett-Ösophagus beschreibt eine Schleimhautmetaplasie in der Speiseröhre, die positiv oder negativ für Becherzellen sein kann. 4) Extraösophageale Erkrankungen können mit GÖRK assoziiert sein, eine Kausalität ist für die meisten nicht gesichert.

Zusammenfassung

Das Konsensuspapier wurde unter strikten Kriterien entwickelt und kann die Basis für klinische Studien und Leitlinien bilden.

Abstract

Objective

An international consensus on the definition of gastroesophageal reflux disease (GERD) in pediatrics was sought.

Methods

After a systematic literature search, a set of key statements was developed by an international panel of pediatric gastroenterologists and voted anonymously in a modified Delphi process. The strength of each statement was assessed using the GRADE system.

Results

Consensus was reached on 98% of the 59 statements. Consensus items of particular note were: (1) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications. The definition is restricted in the case of children under ~8 years, due to unreliable reporting of incriminating symptoms; (2) the primary role of histology is to exclude other conditions, rather than to establish the diagnosis of GERD; (3) Barrett’s esophagus characterizes an esophageal metaplasia that is intestinal metaplasia-positive or -negative; (4) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established.

Conclusions

The consensus statements were developed by means of a rigorous process and can form the basis for clinical trials and practice guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Boccia G, Manguso F, Miele E et al (2007) Maintenance therapy for erosive esophagitis in children after healing by omeprazole: is it advisable? Am J Gastroenterol 102:1291–1297

    Article  CAS  PubMed  Google Scholar 

  2. Chang AB, Lasserson TJ, Gaffney J et al (2006) Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 4:CD004823

    PubMed  Google Scholar 

  3. Debley JS, Carter ER, Redding GJ (2006) Prevalence and impact of gastroesophageal reflux in adolescents with asthma: a population-based study. Pediatr Pulmonol 41:475–481

    Article  PubMed  Google Scholar 

  4. Diaz DM, Winter HS, Colletti RB et al (2007) Knowledge, attitudes and practice styles of North American pediatricians regarding gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 45:56–64

    Article  PubMed  Google Scholar 

  5. Gatta L, Vaira D, Sorrenti G et al (2007) Meta-analysis: the efficacy of proton pump inhibitors for laryngeal symptoms attributed to gastro-oesophageal reflux disease. Aliment Pharmacol Ther 25:385–392

    Article  CAS  PubMed  Google Scholar 

  6. Gupta SK, Hassall E, Chiu YL et al (2006) Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci 51:858–863

    Article  PubMed  Google Scholar 

  7. Hassall E, Kerr W, El-Serag HB (2007) Characteristics of children receiving proton pump inhibitors continuously for up to 11 years duration. J Pediatr 150:262–267

    Article  CAS  PubMed  Google Scholar 

  8. Hetzel DJ, Dent J, Reed WD et al (1988) Healing and relapse of severe peptic oesophagitis after treatment with omeprazol. Gastroenterology 95:903–912

    CAS  PubMed  Google Scholar 

  9. Hill DJ, Heine RG, Cameron DJ et al (2000) Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis. J Pediatr 136:641–647

    Article  CAS  PubMed  Google Scholar 

  10. Kleinman L, Rothman M, Strauss R et al (2006) The infant gastroesophageal reflux questionnaire revised: development and validation as an evaluative instrument. Clin Gastroenterol Hepatol 4:588–596

    Article  PubMed  Google Scholar 

  11. Lehwald N, Krausch M, Franke C et al (2007) Sandifer syndrome – a multidisciplinary diagnostic and therapeutic challenge. Eur J Pediatr Surg 17:203–206

    Article  CAS  PubMed  Google Scholar 

  12. Martin AJ, Pratt N, Kennedy JD et al (2002) Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 109:1061–1067

    Article  PubMed  Google Scholar 

  13. Nelson SP, Chen EH, Syniar GM, Christoffel KK (2000) Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 154:150–154

    CAS  PubMed  Google Scholar 

  14. Nielsen RG, Bindslev-Jensen C, Kruse-Andersen S, Husby S (2004) Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr 39:383–391

    Article  CAS  PubMed  Google Scholar 

  15. Rasquin A, Di LC, Forbes D et al (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537

    Article  PubMed  Google Scholar 

  16. Salvatore S, Hauser B, Vandemaele K et al (2005) Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr 40:210–215

    Article  PubMed  Google Scholar 

  17. Sherman PM, Hassall E, Fagundes-Neto U et al (2009) A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol 104:1278–1295

    Article  PubMed  Google Scholar 

  18. Vakil N, Zanten SV van, Kahrilas P et al (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920

    Article  PubMed  Google Scholar 

  19. Vandenplas Y, Rudolph CD, Di LC et al (2009) Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: joint recommendations of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 49:498–547

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

  1. Gastroenterology-Pediatric, Hospital for Sick Children, University of Toronto, Toronto, Kanada

    P.M. Sherman

  2. Division of Gastroenterology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Kanada

    E. Hassall

  3. Disciplina de Gastroenterologia, Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasilien

    U. Fagundes-Neto

  4. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Atlanta, GA, USA

    B.D. Gold

  5. Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan

    S. Kato

  6. Abteilung für Pädiatrische Gastroenterologie und Hepatologie, Dr. von Haunersches Kinderspital,Ludwig-Maximilians-Universität München, Lindwurmstraße 4, 80337, München, Deutschland

    S. Koletzko

  7. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    S. Orenstein

  8. Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA

    C. Rudolph

  9. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    N. Vakil

  10. Marquette University College of Health Science, Milwaukee, WI, USA

    N. Vakil

  11. Department of Pediatrics, UZ Brussel Kinderen, Vrije Universiteit Brussel, Brüssel, Belgien

    Y. Vandenplas

Authors
  1. P.M. Sherman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Hassall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Fagundes-Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B.D. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Koletzko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Orenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Rudolph
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. N. Vakil
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Y. Vandenplas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Koletzko.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sherman, P., Hassall, E., Fagundes-Neto, U. et al. Gastroösophageale Refluxkrankheit. Monatsschr Kinderheilkd 158, 164–176 (2010). https://doi.org/10.1007/s00112-010-2165-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-010-2165-9

Schlüsselwörter

Keywords

Search

Navigation