Symptoms of gastroesophageal reflux disease in severely mentally retarded people: a systematic review.
BACKGROUND
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently backs up (or refluxes) into the gullet (or esophagus), and it has serious consequences for the quality of life. Usually this is felt as heartburn. Because severely mentally retarded people usually do not utter complaints of heartburn, it requires a high index of suspicion to discover possible GERD. Therefore it is relevant for care professionals such as nurses to have knowledge of those with a higher risk of GERD and of the possible manifestations of GERD.


METHODS
Using a predefined search method, electronic databases were searched for studies relating the presence of symptoms to the presence of GERD. Relevant data were extracted and the methodological quality of the studies assessed. The results of the included studies were synthesized and conclusions about the level of evidence were drawn.


RESULTS
Nineteen studies were found relating symptoms to the presence of GERD. Only four were of good methodological quality. The studies were very diverse concerning the studied population, the study method, and the kind of symptoms examined. This makes it difficult to synthesize the results of the studies. There is evidence that patients with cerebral palsy, patients using anticonvulsive drugs, and those with an IQ lower than 35 more frequently have GERD. There is also evidence that vomiting, rumination and hematemesis are associated with a higher risk of the presence of GERD, whereas there is no clear scientific evidence that particular behavior symptoms are indicative for GERD.


CONCLUSIONS
The possible manifestations of GERD are many and varied. A guideline will be made for care professionals to aid systematic observation of possible manifestations of GERD.
Netherlands institute for health services research, Utrecht, The Netherlands. a.deveer@nivel.nl
Anke J E
AJ
de Veer
Judith T
JT
Bos
Riet C
RC
Niezen-de Boer
Clarisse J M
CJ
Böhmer
Anneke L
AL
Francke
D000328:Adult; D015984:Causality; D002648:Child; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D015995:Prevalence