Gastroesophageal reflux in children with cerebral palsy: Does symptom presence reflect disease severity?

OBJECTIVES: To determine whether the presence of gastroesophageal reflux symptoms in children with cerebral palsy (CP) reflects pathological reflux severity as assessed by 24-h multichannel intraluminal impedance-pH monitoring (MII-pH). METHODS: We conducted a multicenter retrospective review of MII-pH tracings in children with CP (Gross Motor Function Classification System IV-V), aged 1-15 years, evaluated before gastrostomy placement across 11 centers in Argentina, Brazil, Mexico, and Spain. Patients were classified as symptomatic or asymptomatic based on caregiver reports. Reflux index (RI), number and type of reflux episodes, acid clearance time, and mean nocturnal baseline impedance (MNBI) were compared. RESULTS: A total of 201 MII-pH tracings were included. A pathological RI (≥7%) was identified in 18.4% of patients: 23.1% of symptomatic and 12.9% of asymptomatic children (p = 0.03). No significant differences were found in total reflux episodes, acid clearance time, or MNBI. Among symptomatic children, 27% demonstrated a positive symptom-reflux correlation. Respiratory symptoms (p = 0.009), regurgitation (p < 0.001), and rumination (p = 0.005) were associated with reflux events, while most symptoms showed no association. CONCLUSIONS: Children with CP can have abnormal RI in the absence of symptoms. Symptoms do not reliably indicate abnormal acid exposure. These findings highlight the limitations of symptom-based diagnosis and reinforce the value of objective assessment with MII-pH monitoring.