Quality of Life in Children and Adolescents with Gastroesophageal Reflux Disease

Öz

Objective: Children with gastroesophageal reflux disease (GERD) have significant co-morbidity. This study aimed to evaluate the health-related quality of life (HRQoL) in these children and adolescents by self and parent questionnaires. In addition, we also investigated the impact of gastroesophageal reflux symptoms on HRQoL.

Material and Methods: The study included 93 patients with GERD and 59 age and sex-matched healthy controls. We asked the children and their parents to complete the validated Turkish version of KINDer Lebensqualitätsfragebogen-Children Quality of Life Questionnaire (self-report and parent report, respectively) for assessing HRQoL. The patients have additionally completed a gastroesophageal reflux symptom questionnaire.

Results: The patients and their parents scored significantly lower on the general health perception (p=0.004) than the healthy controls. Especially physical well-being and emotional well-being subscales were negatively affected (p=0.000, and p=0.002, respectively). The most common symptoms in the patients were epigastric pain (70.9%), abdominal distention (64.5%), halitosis (58%), and regurgitation (50.6%). Epigastric pain significantly negatively affected the total HRQoL score in the patients (p= 0.003). The patients with GERD scored significantly higher than their parents in physical well-being (p=0.000) and family (p=0.000) subscale scores. The patients with GERD evaluated their quality of life more negatively in self-esteem (p=0.000) and school domains (p=0.001) than did their parents.

Conclusion: GERD has a significant negative impact on HRQoL in children. The most affected domains are physical well-being and emotional well-being. Epigastric pain is associated with worse HRQoL scores.

Anahtar Kelimeler

• Child
• Gastroesophageal reflux
• Quality of life

Gastroözofagiel Reflü Hastalığı Olan Çocuk ve Adolesanlarda Yaşam Kalitesi

Öz

Amaç: Gastroözofageal reflü hastalığı (GÖRH) olan çocukluklarda önemli komorbidite vardır. Bu çalışmada, hasta çocuk ve ergenlerin sağlıkla ilgili yaşam kalitesini (SYK) hastanın kendisi ve ebeveynlerin doldurduğu anketlerle değerlendirmeyi amaçladık. Ek olarak, gastroözofageal reflü semptomlarının SYK üzerindeki etkisi de araştırıldı.

Gereç ve Yöntemler: Çalışmaya 93 hasta ve 59 yaş ve cinsiyet uyumlu sağlıklı kontrol dahil edildi. Yüzyüze görüşmeyle çocuklardan ve ebeveynlerinden çocuğun SYK’ni değerlendirmek için Türkçe geçerli ve güvenilir versiyonu olan KINDer Lebensqualitätsfragebogen-Çocuk Yaşam Kalitesi Anketi’ni doldurmaları istendi. Hastalar ayrıca bir gastroözofageal reflü semptom anketi de doldurdular.

Bulgular: Hastaların ve ebeveynlerinin SYK puanı sağlıklı kontrollere göre anlamlı olarak daha düşük bulundu (p=0.004). Özellikle bedensel iyilik ve duygusal iyilik alt ölçekleri olumsuz etkilenmişti (sırasıyla p=0.000 ve p=0.002). Hastalarda en sık görülen semptomlar epigastrik ağrı (%70.9), karında şişkinlik (%64.5), ağız kokusu (%58) ve regurjitasyon (%50.6)’di. Epigastrik ağrı hastalarda toplam SYK’ni anlamlı olarak olumsuz etkiledi (p= 0.003). Hastalarla ebeveynlerinin doldurduğu anketler karşılaştırıldığında hasta çocukların bedensel iyilik (p=0.000) ve aile (p=0.000) alt ölçek puanları ebeveynlerine göre anlamlı derecede yüksekti. GÖRH olan hastalar, öz saygı (p=0.000) ve okul alanlarındaki yaşam kalitesini (p=0.001) ebeveynlerine göre daha olumsuz olarak değerlendirdi.

Sonuç: GÖRH, çocuklarda SYK üzerinde önemli bir olumsuz etkiye sahiptir. En çok etkilenen alanlar bedensel iyilik ve duygusal iyilik halidir. Epigastrik ağrı, daha kötü SYK skorları ile ilişkilidir.

Anahtar Kelimeler

• Yaşam kalitesi
• Çocuk
• Gastroözofagiel reflü hastalığı

Kaynakça

1. 1-Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009;49:498-547.
2. 2-Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:516-554.
3. 3-Yönem Ö, Sivri B, Özdemir L, Nadir I, Yüksel S, Uygun Y. Gastroesophageal reflux disease prevalence in the city of Sivas. Turk J Gastroenterol 2013;24:303-10.
4. 4-Mungan Z. Prevalence and demographic determinants of gastroesophageal reflux disease (GERD) in the Turkish general population: a population-based cross-sectional study. Turk J Gastroenterol 2012;23:323-32.
5. 5-Bor S, Kitapcioglu G, Kasap E. Prevalence of gastroesophageal reflux disease in a country with a high occurrence of Helicobacter pylori. World J Gastroenterol 2017;23:525-532.
6. 6-Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health 2019;39:7-12.
7. 7-Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013;131:e1684-95.
8. 8-Lee SW, Lee TY, Lien HC, Peng YC, Yeh HJ, Chang CS. Correlation Between Symptom Severity and Health-Related Life Quality of a Population With Gastroesophageal Reflux Disease. Gastroenterology Res 2017;10:78-83.

9. 9-Revicki DA, Wood M, Maton PN, Sorensen S. The impact of gastroesophageal reflux disease on health-related quality of life. Am J Med 1998;104:252-8.
10. 10-Eloubeidi MA, Provenzale D. Health-related quality of life and severity of symptoms in patients with Barrett's esophagus and gastroesophageal reflux disease patients without Barrett's esophagus. Am J Gastroenterol 2000;95:1881-7.
11. 11-Okuyama M, Takaishi O, Nakahara K, Iwakura N, Hasegawa T, Oyama M, et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scand J Gastroenterol 2017;52:44-49.
12. 12-Varni JW, Bendo CB, Nurko S, Shulman RJ, Self MM, Franciosi JP, et al. Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr 2015;166:85-90.
13. 13-Marlais M, Fishman JR, Köglmeier J, Fell JM, Rawat DJ. Reduced quality of life in children with gastro-oesophageal reflux disease. Acta Paediatr 2010;99:418-21.
14. 14-Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol 2009;104:1278-95; quiz 1296.
15. 15-Eser E, Yüksel H, Baydur H, Erhart M, Saatli G, Cengiz Ozyurt B, ve ark. Cocuklar için genel amaçli sağlikla ilgili yaşam kalitesi ölçeği (Kid-KINDL) Türkçe sürümünün psikometrik özellikleri [The psychometric properties of the new Turkish generic health-related quality of life questionnaire for children (Kid-KINDL)]. Turk Psikiyatri Derg 2008;19:409-17.
16. 16-Bullinger M, Brütt AL, Erhart M, Ravens-Sieberer U; BELLA Study Group. Psychometric properties of the KINDL-R questionnaire: results of the BELLA study. Eur Child Adolesc Psychiatry 2008;17 Suppl 1:125-32.
17. 17-Erhart M, Ellert U, Kurth BM, Ravens-Sieberer U. Measuring adolescents' HRQoL via self reports and parent proxy reports: an evaluation of the psychometric properties of both versions of the KINDL-R instrument. Health Qual Life Outcomes 2009;7:77.
18. 18-Questionnaire for measuring health-related quality of life in children and adolescents, revised version. Manual. Erişim Tarihi: 12 Aralık 2021. Available from: https://www.kindl.org/english/manual/
19. 19-Koçyiğit, E. Gastroözofageal reflü hastalığında yaşam kalitesinin incelenmesi. (Yayınlanmamış uzmanlık tezi). Bursa: Uludağ Üniversitesi Tıp Fakültesi, 2016.
20. 20-Quitadamo P, Di Nardo G, Miele E, Campione S, Mancusi V, Oliva S, et al. Gastroesophageal reflux in young children and adolescents: Is there a relation between symptom severity and esophageal histological grade? J Pediatr Gastroenterol Nutr 2015;60:318-21.
21. 21-Mahoney LB, Mitchell PD, Fishman E, Lurie M, Rosen R. Abnormal 24-hour pH-impedance Testing Does Not Predict Reduced Quality of Life in Children With Reflux Symptoms. J Pediatr Gastroenterol Nutr 2020;70:31-36.
22. 22-Kamolz T, Velanovich V. Psychological and emotional aspects of gastroesophageal reflux disease. Dis Esophagus 2002;15:199-203.
23. 23-Foong RX, Meyer R, Godwin H, Dziubak R, Lozinsky AC, Reeve K, et al. Parental perception of their child's quality of life in children with non-immunoglobulin-E-mediated gastrointestinal allergies. Pediatr Allergy Immunol 2017;28:251-256.
24. 24-Acierno SP, Chilcote HC, Edwards TC, Goldin AB. Development of a quality of life instrument for pediatric gastroesophageal reflux disease: qualitative interviews. J Pediatr Gastroenterol Nutr 2010;50:486-92.
25. 25-Ravens-Sieberer U, Erhart M, Wille N, Bullinger M; BELLA study group. Health-related quality of life in children and adolescents in Germany: results of the BELLA study. Eur Child Adolesc Psychiatry 2008;17 Suppl 1:148-56.
26. 26-Robitail S, Siméoni MC, Ravens-Sieberer U, Bruil J, Auquier P; KIDSCREEN Group. Children proxies' quality-of-life agreement depended on the country using the European KIDSCREEN-52 questionnaire. J Clin Epidemiol 2007;60:469-78.
27. 27-Kobayashi K, Kamibeppu K. Quality of life reporting by parent-child dyads in Japan, as grouped by depressive status. Nurs Health Sci. 2011;13:170-7.
28. 28-Jozefiak T, Larsson B, Wichstrøm L, Mattejat F, Ravens-Sieberer U. Quality of Life as reported by school children and their parents: a cross-sectional survey. Health Qual Life Outcomes 2008;6:34.
29. 29-Kalyva E, Eiser C, Papathanasiou A. Health-Related Quality of Life of Children with Asthma: Self and Parental Perceptions. Int J Behav Med 2016;23:730-737.
30. 30-Kalyva E, Abdul-Rasoul M, Kehl D, Barkai L, Lukács A. A cross-cultural study on perceived health-related quality of life in children and adolescents with type 1 diabetes mellitus. J Diabetes Complications. 2016;30:482-7.