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Table 2 Characteristics of included studies (n = 19)

From: Symptoms of gastroesophageal reflux disease in severely mentally retarded people: a systematic review

First author + data collection method+ quality points Setting Characteristics research group (number, age, sex, impairment) Reference test Verification bias possible? Selection bias possible? Spectrum bias possible?
Böhmer et al. [21]
Inspection of teeth + reference test
q.p. = 5
Random selection of residents with IQ < 50 of 3 institutes for mentally retarded people GERD group: 28
Control group: 35 (tested negative for GER)
Mean age 22.8 years.
48% males, 52% females
IQ < 50
24 hour pH test No No No
Böhmer et al. [10]
Review of record
q.p. = 4
All residents with IQ < 50 of 5 institutes for mentally retarded people GERD group: 107
Control group: 1,580 (1,518 subjects not tested for GER and 62 subjects tested negative for GER)
Mean age 35.3 years (range 2–92 years).
61% males, 39% females
IQ < 50
Endoscopy Yes No No
Böhmer et al. [17]
Questionnaire + reference test
q.p. = 3
Residents of 1 institute for mentally retarded people with IQ < 50 and with symptoms of GER GERD group: 57
Control group: 46 (tested negative for GER)
Mean age 38.4 years (range 4–75 years)
63% males, 37% females
IQ < 50
24 hour pH test No Yes Yes
Böhmer et al. [7]
Questionnaire + reference test
q.p. = 5
Persons with IQ < 50 randomly selected in six also randomly selected institutes for people with intellectual disability. GERD group: 186 persons
Control group: 200 persons (tested negative for GER)
Mean age 35 years, 40% females
IQ < 50
24 hour pH test No No No
Cameron et al. [23]
Review of records
q.p. = 2
All subjects without GER who received a gastronomy tube
Evaluation of an intervention
Intervention group: 63 children
Mean age 3.5 years (range 1 month-17 years)
Sex: 52% males, 48% females
All children were neurologically impaired
Pretest: UGI-studies, pH test, or esophageal biopsy
Post test: ?
Yes No Yes
Field et al. [13]
Review of records
q.p. = 2
All children referred to an interdisciplinary feeding program for the evaluation of feeding problems GERD group: 178 children
Control group: 171 children tested negative or not tested
Median age 13–36 months (range 1 month-12 years)
57% boys, 43% girls.
64% with developmental disabilities
Diverse: in most cases endoscopy, pH test and/or radiographic studies Yes No Yes
Gustafsson et al. [11]
Review of records + reference test
q.p. = 3
All children who visited an outpatient clinic
It is not clear for what reasons the children visited the outpatient clinic
GERD group: 25 children
Control group: 7 children negatively tested
Mean age 11.2 years (range 0.7 – 19 years).
34% boys, 66% girls.
All have cerebral palsy with severe brain damage (66%) or severe mental retardation with cerebral atrophy (34%)
24 hours pH test No No Yes
Halpern et al. [19]
Review of records and/or questionnaire by parents
q.p. = 4
All children referred to a pediatric surgical service for detection, quantification or surgical treatment of GER GERD group: 69 children
Control group: 57 children negatively tested
Age range 1 – 16 years.
Sex: ?
Impairment: 36% CNS disease
18–24 hours pH test No No Yes
Heine et al. [24]
Questionnaire + review of records
q.p. = 2
All children without or with mild GER after gastronomy
Evaluation of an intervention.
Intervention group: 30 children
Mean age 6 years (range 3 months-17 years)
Sex: 60% boys, 40% girls
All children were neurologically impaired
23 had intellectual disability
Pretest: 24 hours pH test + esophageal biopsy
Post test: Probably 24 hours pH test + endoscopy
No No Yes
Lin et al. [20]
Interview (parent) + reference test (to check if the selection was correct)
q.p. = 2
All children diagnosed as GERD patients in the University Hospital GERD group: 34 children.
No control group
Median age 2.5 years (range 1.1–9.7 years)
53% boys, 47% girls
14 children had a neurological disorder, 10 had other diseases, 10 did not have an underlying disease
24 hour pH test Yes No Yes
Luzzani et al. [12]
Questionnaire + reference test
q.p. = 2
Patients with Cornelia de Lange Syndrome
Strategy of
recruitment is unclear
GERD group: 28
Control group: 15 with normal pH test
Mean age 6.5 years (range 1 month- 30 years)
18 males and 25 females
24 hour pH test and endoscopy No Yes Yes
Martinez et al. [18]
Review of records
q.p. = 1
Subjects with antireflux operation and after operation tested with a reference test GERD group: 47 children
Control group: 55 children tested negative
Age: children over 2 years of age.
Sex: ?
All have severe cognitive and motor impairment
Diverse: upper gastrointestinal contrast study (barium), nuclide chalasia scan, upper endoscopy, extended pH study Yes Yes Yes
Orchard et al. [15]
Review of records
q.p. = 3
All persons who reside in a long-term care facility and are admitted to a hospital with UGI tract bleeding GERD group: 28 adults
Control group: 12 adults
Mean age 42 years, 78% males
All are mentally retarded, 87% with IQ < 35–40
endoscopy No No Yes
Ravelli et al. [16]
Reference test, it is not clear how symptoms were measured
q.p. = 2
Children who suffered retching and/or vomiting and were referred to a hospital for suspected gastrointestinal disorder GERD group: 13 children
Control group: 6 children
Age: approx. 4.5 years
Sex: approx. 50% boys
All children selected for this review have CNS disorder and do not suffer gastric dysrhythmias
24 hour pH test and endoscopy No Yes Yes
Rogers et al. [14]
Reference test + questionnaire about regurgitation to select subjects
q.p. = 2
Subjects living in a residential facility with a history of regurgitating food into the mouth for a minimum of 3 months GERD group: 16 adults
Control group: 7 adults negatively tested
Age range 28–65 years
10 males, 13 females
All with severe developmental disabilities 61% had cerebral palsy
Radiological studies No Yes No
Shaw et al. [22]
Observation of teeth + reference test
q.p. = 2
Children attending a dental outpatient clinic of a hospital GERD group: 12 children.
Control group: 9 children with normal pH test
Mean age 12.5 years (range 3.9 – 20.7 years)
Sex: ?
All have cerebral palsy
24 hour pH test No Yes Yes
Wadie et al.
[25]
Review of records
q.p. = 1
All subjects without GER who received a gastronomy tube
Evaluation of an intervention.
Intervention group: 56 children
Mean age 4.4 years
Sex: ?
All children were neurologically impaired
Pretest: upper gastrointestinal studies, sometimes followed by a milk scan
Post test: ?
Yes No Yes
Van Winckel [9]
Interview with caregivers + review of records + reference test
q.p. = 3
All children of a Pediatric Institute with IQ < 30 combined with severe motor disorders GERD group: 46 children (45 with symptoms of GERD and tested positive + 1 asymptomatic child that is tested positively)
Control group: 38 children (9 with symptoms but negative reference test, 2 without symptoms and negative reference test, 12 without symptoms and not tested, 15 with symptoms but not tested because parents refused the test)
Mean age 13 years (range 2–18 years)
52% boys, 48% girls
IQ < 30 combined with severe motor disorders
24 hour pH test and endoscopy Yes No Yes
Vega Gutierrez et al. [26]
Review of records
q.p. = 2
All children with neurological or psychiatric problems who visited an neuropediatric outpatient clinic GERD group: 27 children
Control group: 113 children, not tested or negatively tested
Median age 7.7 years (range 8 months-18 years)
67% boys, 33% girls;
32% had moderate to severe mental retardation
Barium ingestion with fluoroscopy and/or eso-phascopy Yes No Yes
  1. ? information not found in publication