The relationship of response to treatment of duodenogastric reflux disease and constipation with prognosis in children

The Relationship of Response to Treatment of Duodenogastric Reflux Disease and Constipation with Prognosis in Children DGR; is defined as the reflux of alkaline bile, pancreatic, and small intestine secretions in the duodenum into the stomach. Physiologically, the contents of the duodenum after feeding, during sleep, and morning fasting; may escape back into the stomach in small amounts and for a short time. However, as a result of excessive and long-term DGR, secretions in the duodenum cause damage and inflammation in the gastric mucosa. It is thought that bile acids, pancreatic enzymes, and small intestine secretions together cause stomach damage. The occurrence of symptoms such as nausea, vomiting, and abdominal pain due to this damage and the formation of pathological conditions such as gastritis, ulcer, metaplasia, and carcinoma in the gastric mucosa are called DGRD. There is no gold standard for the diagnosis of DGRD, but the presence of gastric mucosal erythema, erosion, ulcer, duodenal secretion content, and abundant bile pool in the stomach seen on endoscopy are helpful for the diagnosis. The most common etiological cause in adults is previous operations. However, primary DGRD is seen as the most common etiologic cause in children. There is limited data on DGRD in children and there is no standard approach for its treatment. In this study; 91 pediatric patients who presented with reflux symptoms resistant to anti-acid therapy and were diagnosed with DGRD by upper GI endoscopy were evaluated. To evaluate the risk factors and etiology of DGRD in these patients, we examined the demographic characteristics (gender, age, weight, height, weight-height percentiles, consanguinity, family history, nutritional characteristics, defecation characteristics), clinical findings, and prognostic factors. Of the patients in our study, 59 (64.8%) were female and 32 (35.2%) were male. The mean age of the patients was 14.12±2.91. In our study, DGRD was observed to be more common in female gender and adolescent age groups. The patients were divided into two groups according to their treatment modalities and compared. Those who used UDCA and sucralfate in their treatment were determined as Group 1; Those who used UDCA, sucralfate, and Macrogol 3350 were determined as Group 2. Post-treatment symptoms and clinical staging of patients were evaluated. When all patients were evaluated, a statistically significant decrease was observed in the complaints of epigastric pain/burning, nausea, vomiting, indigestion, constipation, anorexia, and weight loss in both groups after treatment. In the comparison between the groups according to the type of treatment, no significant difference was found between clinical stage score changes. However, a statistically significant decrease was observed in the complaints of epigastric pain/burning and constipation in Group 2 patients using Macrogol 3350 compared to the group not used. In conclusion; Preferring Macrogol 3350 in addition to UDCA and sucralfate treatment in the regimen to be applied to patients in the treatment of DGRD-related symptoms contributes to the regression of epigastric pain/burning and constipation complaints in patients and has a positive effect on the prognosis of the disease. Keywords: Duodenogatric Reflux, Constipation, Ursodeoxycholic acid, Sucralfate, Polyethylene glycols, Macrogol 3350