GASTROESOPHAGEAL REFLUX DISEASE IN INSTITUTIONALIZED INTELLECTUALLY DISABLED INDIVIDUALS

Background. The prevalence of reflux oesophagitis (RO) in the normally intellectual population is about 2%, while this condition in the inte llectually disabled has an estimated prevalence of 10%. Methods. We in vestigated the presence of RO among 1687 intellectually disabled, with an IQ < 50, from 5 different institutes in the Netherlands. All were scored for possible associated factors and reflux symptoms, and compar ed with the overall population (n = 1580) from the same institutes (co ntrols). Also, the effect of treatment on symptoms was evaluated after at least one year of therapy. Results. Gastro-oesophageal reflux dise ase (CORD) was suspected clinically in 169 patients based on the follo wing symptoms: vomiting, haematemesis, anaemia, rumination or behaviou r problems. At endoscopy RO was diagnosed in 107 of 1687 patients (6.4 %): 17 (15.9%) grade I, 34 (31.8%) gr. II, 42 (39.3%) gr. III and 14 ( 13.1%) gr. IV RO (Savary-Miller classification). Cerebral palsy, const ipation, anticonvulsant drugs, an IQ < 35, underweight and gastrostomy feeding appeared to be possible associated factors, while as reflux s ymptoms persistent vomiting, haematemesis, iron deficiency anaemia, ru mination, and behaviour problems were found. Concerning therapy, surge ry was found to be effective in 38%, H-2 receptor antagonists in 60% a nd the proton-pump inhibitor omeprazole in 96%. Conclusions. In this g roup of Dutch intellectually disabled patients with IQ < 50 RO was dia gnosed in about 6% (107 of 1687), mostly severe grades of oesophagitis . Several possible associated factors were significantly present. From non-specific reflux symptoms persistent vomiting was the most indicat ive factor. In this population the most effective treatment of RO was long-term omeprazole therapy. (C) 1997 Elsevier Science B.V.