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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