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[Gastroesophageal reflux in neurologically impaired children]
Shigehiko Yoshida1, Takamichi Kamiyama, Masaki Nio
1Department of Pediatric Surgery, Tohoku University, School of Medicine, Sendai, Miyagi. yoshida@ped-surg.med.tohoku.ac.jp
Insights
Surgical treatment for neurologically impaired children with gastroesophageal reflux (GER) involves fundoplication. For intractable aspiration, laryngotracheal separation is recommended when anti-reflux procedures fail.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Context:
- Neurologically impaired children often suffer from gastroesophageal reflux (GER).
- Assessing GER requires clinical symptoms, upper GI series, esophageal pH monitoring, and GI endoscopy.
- Quality of life for patients and families is a key consideration.
Purpose:
- To outline the indications, procedures, and outcomes of surgical interventions for GER in neurologically impaired children.
- To evaluate the effectiveness of different surgical approaches based on patient condition.
Summary:
- Laparoscopic fundoplication is the preferred surgical treatment for GER due to its efficacy.
- Anti-reflux procedures are insufficient for managing intractable aspiration.
- Laryngotracheal separation is indicated for severe aspiration cases unresponsive to other treatments.
Impact:
- Informed surgical decision-making for pediatric GER.
- Improved management strategies for neurologically impaired children with complex feeding and respiratory issues.
- Guidance on selecting appropriate surgical interventions to enhance patient quality of life.
Abstract:
We present here the indication, procedure and results of surgical treatment of gastroesophageal reflux (GER) for neurologically impaired children. We decide its indication based on clinical symptoms and findings of upper GI series, esophageal pH monitoring and GI fiberscopy, respecting the QOL of the patient and family. Laparoscopic fundoplication has become the first choice in surgical treatment of GER because of its good results. However, an anti-reflux procedure is not effective in patients with intractable aspiration. A laryngotracheal separation procedure should be applied for these cases.