Background
Although gastro-esophageal reflux disease (GERD) is the most frequent long-term morbidity in congenital diaphragmatic hernia (CDH) survivors, no consensual guidelines exist regarding this associated comorbidity. The aim of this study was to assess practices regarding GERD diagnosis and treatment in children born with CDH at a national level.
Methods
An online questionnaire was sent to the 29 centers from the National Reference Centre for CDH. Responses were collected between April and May 2020.
Results
The response rate was 100% (n = 29). In 38% of centers, preventive fundoplication during CDH repair was sometimes considered, whereas in 62%, this practice was never performed. The criteria for performing this surgery were: large defect requiring a patch/muscle flap (91%), intrathoracic stomach (36%)/liver (27%). When preventive fundoplication was performed, an associated gastrostomy was systematically inserted in 36% (n = 4) or never in 55% (n = 6) of centers. In centers that did not perform preventive fundoplication (n = 18), this was justified by department habits (44%), poor evidence/absence of guidelines (44%), and thoracoscopic CDH repair (17%). After CDH repair, anti-reflux medication was systematically administered in 59% of centers (3 months to 2 years). Investigations for GERD diagnosis were never performed systematically before discharge, and in 7% of centers during follow-up.
Conclusion
Despite the prevalence of GERD, practices regarding preventive fundoplication and GERD management in children with CDH vary strongly. Prospective multi-institutional studies are needed to establish guidelines for this fragile cohort of patients.
