Gastroesophageal reflux in congenital diaphragmatic hernia survivors: objective diagnostics reveal clinically relevant disease beyond reported symptoms

Abstract Purpose While gastroesophageal reflux disease (GERD) is a frequent comorbidity in congenital diaphragmatic hernia (CDH), there is no consensus about a standardized screening strategy within the speciality. Reported prevalence is heterogeneous, and the role of anti-reflux surgery remains controversial. This single-center study aimed to assess the reliability of symptom inquiry, age-dependent prevalence, the impact of GERD on thriving and lung function, and CDH-inherent predispositions. Methods Records of 1250 CDH-patients treated between 2000 and 2022 were reviewed. Associations of GER with symptoms, weight gain, and respiratory function were analyzed. A multivariate regression model was used to identify risk factors. Results Of 1250 patients, 916/964 survivors were followed for a median of 8.7 years [IQR 4.2–13.4]. Reflux-associated symptoms were reported in 18.0%. Esophagogastroduodenoscopy (EGD) was performed in 85 patients, pH-metry in 58 (50 pH-MII). Pathologic findings were detected in 5.2% of the patients. 115 contrast studies showed reflux in further 8.2%. Anti-reflux surgery was performed in 6.9%. Reported gastrointestinal symptoms were associated with higher 24 h-reflux count (74.9 ± 40.7 vs. 51.0 ± 32.8, p = 0.033). Weight gain correlated negatively with esophagitis severity ( r =-0.25, p = 0.04) and acid exposure time (-0.41, p = 0.004). Obstructive lung function correlated with the endoscopic grade of esophagitis ( r =-0.52, p = 0.04). Larger CDH-defect size and liver herniation were the only significant predisposing factors for GERD. Conclusion CDH patients, especially those with large defects, are at high risk for GERD, which impairs thriving and lung function. Because symptoms poorly reflect objective findings, structured follow-up including EGD and pH-MII is essential.