Evaluation of etiology, clinical findings and prognosis related factors in children with duodenogastric reflux diagnosis

Duodenogastric reflux (DGR) is the clinical manifestation of bile, pancreas and small bowel contents in the duodenum. The content of the duodenum can be delivered back to the stomach after physiological feeding during the day, evening sleep or fasting in the morning. Duodenogastric reflux disease (DGRD) is the formation of pathological conditions such as gastritis, ulcer, carcinoma and indigestion due to mucosal damage as a result of retrograde passage to the stomach. Whereas gastric operations are considered to be the most common etiologic causes of DGRD in adults, gastrointestinal motility disorders, duodenum, pancreatic duct and biliary tract anatomic pathologies are thought to be more frequent because gastric operations are rare in children. In this study, 33 patients greater or equal to 10 years of age and presented with refractory reflux symptoms unresponsive to ppi treatment were endoscopically diagnosed as DGRD. As demographic characteristics of these patients age, gender, consanguinity, family history were evaluated. In addition, in case of gastric motility disorder in the etiology, prolongation of gastric emptying time, and clinical and laboratory prognosis of patients receiving UDCA + sucralfate treatment were evaluated. Patients with and without H. pylori were divided into two groups and the relationship between H. pylori and clinical symptoms was evaluated. Staging was performed for the prognosis of the disease. Of the 33 patients with DGRD, 25 (75.8%) were female, 6 (18.2%) with a history of consanguinity between parents, and 2 (6.1%) with a family history. Gastric emptying time was longer in 23 (71.9%) of 32 patients. Of the 33 patients, 9 (27.3%) were H. pylori positive and did not receive eradication therapy. Seventeen and 16 patients received UDCA and sucralfate treatment for 3-4 and 6 months, respectively. When patients were evaluated with clinical staging, a statistically significant improvement was observed regardless of treatment duration. Sixteen of 33 patients had undergone postoperative endoscopy. Histopathologically, there was a significant clinical improvement independent from treatment duration. In conclusion, the frequency of female gender was increased and it was found to be common in adolescent age group. In the etiology, gastric motility disorder might exist without concomitant disease and evaluation of gastric emptying time would be appropriate. Staging provides more accurate information about the prognosis of the disease, and UDCA+sucralfate treatment decreases the prognosis and provides histopathological improvement DGRD. Keywords: Duodenogastric reflux, gastric emptying time, Helicobacter pylori, clinical staging, ursodeoxycholic acid and sucralfate combined therapy