Surgery for gastroesophageal reflux in children with normal pH studies

Area of Science:

• Pediatric Gastroenterology
• Surgical Gastroenterology

Background:

• Esophageal pH monitoring is the standard diagnostic tool for gastroesophageal reflux (GER).
• Surgical intervention for GER is typically recommended only when pH monitoring is abnormal.
• False-negative pH studies can lead to delayed or missed diagnoses and treatment.

Purpose of the Study:

• To evaluate the outcomes of surgical intervention for GER in children with initially normal pH monitoring results.
• To highlight the importance of clinical judgment and complementary diagnostic tests in diagnosing GER.
• To emphasize that surgery should not be withheld in cases of clinically indicated GER despite normal pH data.

Main Methods:

• Retrospective review of 14 pediatric patients who underwent surgery for GER despite normal pH monitoring.
• Analysis of clinical features, radiological evidence, endoscopic findings, and histological esophagitis.
• Assessment of lower esophageal sphincter pressure and esophageal motility.
• Evaluation of postoperative symptom relief.

Main Results:

• All 14 patients had radiological evidence of GER; 10 had esophagitis.
• Despite normal pH monitoring, patients showed decreased lower esophageal sphincter pressure and abnormal esophageal motility.
• 13 out of 14 patients experienced significant symptom relief after surgery.
• One patient had persistent dysphagia postoperatively.

Conclusions:

• Diagnosis of GER should consider clinical judgment and multiple abnormal tests, even with normal pH monitoring.
• Surgical intervention for GER is effective in selected pediatric cases with false-negative pH studies.
• Alkaline reflux is a potential cause of false-negative pH studies and requires further investigation in children.