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Updated: Jul 15, 2026
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Published on: August 11, 2023
Omeprazole maintenance therapy for gastroesophageal reflux disease after failure of fundoplication
D Pashankar1, G K Blair, D M Israel
1Division of Gastroenterology, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Long-term omeprazole effectively treats severe gastroesophageal reflux (GER) in children after failed fundoplication. This well-tolerated medication improves GER symptoms and esophagitis, offering an alternative to repeat surgery.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Pharmacotherapy
Background:
- Recurrent gastroesophageal reflux (GER) in children post-fundoplication presents significant management challenges.
- Previous surgical intervention (fundoplication) failure necessitates alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of omeprazole for managing severe GER in pediatric patients following failed fundoplication.
- To determine if omeprazole can prevent the need for further surgical procedures.
Main Methods:
- Retrospective chart review of children treated with omeprazole for GER after failed fundoplication (1990-1999).
- Clinical and endoscopic assessments were performed at multiple intervals throughout treatment.
- Follow-up included evaluation of GER symptoms, esophagitis severity, and need for subsequent interventions.
Main Results:
- Fifteen of eighteen children with GER post-fundoplication showed marked improvement in symptoms and esophagitis severity with omeprazole.
- Esophagitis remission was maintained during omeprazole treatment, and no further surgeries were required.
- Omeprazole was well-tolerated, with only minor adverse effects (gastric polyps) observed in a few patients.
Conclusions:
- Omeprazole serves as an effective and well-tolerated long-term medical therapy for pediatric gastroesophageal reflux disease refractory to fundoplication.
- Omeprazole should be considered a primary treatment option before pursuing repeat surgical interventions in this patient population.
Background:
Recurrence of gastroesophageal reflux (GER) in children after failed fundoplication poses a therapeutic challenge. The authors report the experience with long-term omeprazole for children with severe GER after failed fundoplication.
Methods:
The authors reviewed the charts of all children who were treated with omeprazole for GER subsequent to failed fundoplication from 1990 to 1999. All underwent endoscopic and clinical assessment of the treatment at baseline, at 3-5 months, at 6-9 months, and annually.
Results:
Eighteen children presented with GER, after a total of 27 fundoplications. Ten had corrected esophageal atresia, 6 had neurologica impairment, and 2 had hiatal hernia. The mean age of presentation of children with recurrence of GER was 7.8 years, and symptoms of GER occurred 4.9 years (range, 0.6-13) after last fundoplication. Fifteen patients had a mean follow-up of 4.4 years for omeprazole. Ten patients had grade III/IV esophagitis and 5 had grade II esophagitis at presentation after fundoplication. Marked improvement was noted in symptoms of GER and severity of esophagitis while taking omeprazole. Remission of esophagitis was maintained while the patient was taking omeprazole and none had further surgery. There was no recurrence of peptic strictures in eight of nine children on omeprazole, after initial esophageal dilatations. Except for benign gastric polyps in three patients, no clinical adverse effects were observed.
Conclusions:
Omeprazole is an effective long-term drug for gastroesophageal reflux disease after failed fundoplication in children. Omeprazole was well-tolerated by all children and should be tried before subsequent surgical intervention.
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