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Reported prevalence is heterogeneous, and the role of anti-reflux surgery remains controversial. This single-center study aimed to assess the reliability of symptom inquiry, age-dependent prevalence, the impact of GERD on thriving and lung function, and CDH-inherent predispositions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Records of 1250 CDH-patients treated between 2000 and 2022 were reviewed. Associations of GER with symptoms, weight gain, and respiratory function were analyzed. A multivariate regression model was used to identify risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1250 patients, 916\/964 survivors were followed for a median of 8.7 years [IQR 4.2\u201313.4]. Reflux-associated symptoms were reported in 18.0%. Esophagogastroduodenoscopy (EGD) was performed in 85 patients, pH-metry in 58 (50 pH-MII). Pathologic findings were detected in 5.2% of the patients. 115 contrast studies showed reflux in further 8.2%. Anti-reflux surgery was performed in 6.9%. Reported gastrointestinal symptoms were associated with higher 24\u00a0h-reflux count (74.9\u2009\u00b1\u200940.7 vs. 51.0\u2009\u00b1\u200932.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). Weight gain correlated negatively with esophagitis severity (\n                      <jats:italic>r<\/jats:italic>\n                      =-0.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) and acid exposure time (-0.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Obstructive lung function correlated with the endoscopic grade of esophagitis (\n                      <jats:italic>r<\/jats:italic>\n                      =-0.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Larger CDH-defect size and liver herniation were the only significant predisposing factors for GERD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CDH patients, especially those with large defects, are at high risk for GERD, which impairs thriving and lung function. Because symptoms poorly reflect objective findings, structured follow-up including EGD and pH-MII is essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-026-06409-3","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:59:13Z","timestamp":1779184753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastroesophageal reflux in congenital diaphragmatic hernia survivors: objective diagnostics reveal clinically relevant disease beyond reported symptoms"],"prefix":"10.1007","volume":"42","author":[{"given":"Julia","family":"Elrod","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Klensch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasul","family":"Khasanov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meike","family":"Weis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela","family":"Klinke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Riemer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Boettcher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Martel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"6409_CR1","doi-asserted-by":"publisher","unstructured":"Armstrong D, Bennett J, Blum A et al (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement., 1996, 111. https:\/\/doi.org\/10.1053\/gast:v111","DOI":"10.1053\/gast:v111"},{"key":"6409_CR2","doi-asserted-by":"publisher","first-page":"e651","DOI":"10.1542\/peds.2006-3040","volume":"120","author":"G Study","year":"2007","unstructured":"Congenital Diaphragmatic Hernia, Study G, Lally KP, Lally PA et al (2007) Defect size determines survival in infants with congenital diaphragmatic hernia. 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