G196(P) A service evaluation of the pharmacological management of gastro-oesophageal reflux disease (GORD) in children with cerebral palsy (CP), and their communicative ability

Abstract

Aims To gather information to plan a randomised controlled trial (RCT) assessing available medications for GORD in children with CP. Methods GORD in children with CP causes distress and pain, and may require hospital admission. There are approximately 8000 children with CP aged 5–16 in the UK and half of these children suffer from GORD. Many children with CP remain on drugs for GORD into adulthood with side-effects and cost-implications. These drugs have been assessed in healthy children but little is known about their benefits for children with CP. Further definition of this group is part of a research recommendation of the NICE Guidelines on managing GORD in children. 1 Information from this service evaluation will contribute towards a planned RCT into currently used pharmacological treatments for GORD in children with CP. Understanding the communicative ability of children with significant CP (Gross Motor Functional Classification System level III-V) will help us ascertain how able these children will be to participate in symptom-based questionnaires. Our coding department identified all children within the region with an ICD-10 diagnosis of CP (G80) and GORD (K21), admitted between 01/01/05 and 31/12/15. 54 children were identified with CP and GORD: their records were screened and data collected on the anti-reflux medication prescribed, the length of time on each medication and their communicative ability. Results The most frequently prescribed anti-reflux medication was omeprazole (70%), with patients remaining on it for an average of 35 months (range 2–120 months). 30% patients had trialled ranitidine: on average for 19 months (4–35 months). Despite the recent MHRA alert of domperidone associated with cardiac side effects 2 59% of children were on this medication for a comparatively long time: mean 38 months (range 1–104 months). 30% of patients assessed could converse, 41% used communication aids (Ipads or PECS) and a majority (65%) could indicate pain. Conclusion CP patients remain on a diverse range of anti-reflux medications and understanding the distribution of communicative ability helps effective research in these children, including the choice of outcome assessment tools.