PULMONARY COMPLICATIONS OF GASTROESOPHAGEAL REFLUX/HIATAL HERNIA IN CHILDREN

As part of a retrospective analysis of gastroesophageal reflux (GER) and/or hiatal hernia (HH) in infants and children, all chest films obtained during the month prior to or following an upper gastrointestinal study on 507 consecutive children (April 73-June 75) were reviewed for pulmonary abnormalities (clinically manifest or unsuspected) consisting of either single or multiple areas of consolidation, emphysema, or both. GER and/or HH was found in 209 (41%) of the total group studied and in 55 (67%) of the 82 children with positive chest findings (P<0.001). The 55 pulmonary cases with GER and/or HH were significantly different in age distribution from the 27 patients without abnormalities of the cardia with 48/55 (87%) of the first group aged one year and under while only 14/27 (52%) of the second group fell into this age group (P<0.001). The clinical course and resolution of pulmonary abnormalities by x-ray were related to the presence or absence of cardioesophageal (CE) abnormalities in that either chronic, shifting, and/or recurrent changes were found in 9/27 (33%) of cases without and 26/55 (47%) of cases with GER and/or HH. Finally, in those cases with GER/HH, persistent pulmonary changes occured in 21/35 (60%) with major reflux (grades 3-5) but in only 5/20 (25%) with minor reflux (grades 1 - 2, delayed only) and hiatal hernia only (P<0.02). Tufts Medical School (New England Medical Center Hospital) Department of Pediatrics, Boston.