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Gastroesophageal reflux following percutaneous endoscopic gastrostomy in children
J E Grunow1, A al-Hafidh, W P Tunell
1Department of Pediatrics, Oklahoma City, OK.
Insights
Percutaneous endoscopic gastrostomy (PEG) can lead to significant gastroesophageal reflux (GER) in children. Post-PEG monitoring revealed increased GER, with half developing symptoms within 10 months.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
Background:
- Gastroesophageal reflux (GER) is a common concern in pediatric patients.
- Percutaneous endoscopic gastrostomy (PEG) is a procedure used for nutritional support.
Purpose of the Study:
- To determine the frequency and clinical significance of GER after PEG placement in children.
- To assess changes in esophageal pH monitoring post-PEG.
Main Methods:
- Ten pediatric patients with normal preoperative esophageal pH monitoring underwent repeat monitoring after PEG placement.
- Esophageal pH scores were compared before and after the PEG procedure.
Main Results:
- Six out of ten patients developed GER post-PEG, indicated by significantly higher pH scores (129.5 vs. 40.5, P < .005).
- Patients with GER had higher post-PEG pH scores compared to those without (129.5 vs. 33.8, P < .005).
- 50% of patients with GER developed reflux-related symptoms within 10 months post-surgery.
Conclusions:
- PEG placement is associated with the development of clinically significant GER in pediatric patients.
- GER following PEG may not be immediately symptomatic but can manifest later.
- Esophageal pH monitoring is crucial for evaluating GER after PEG.
Abstract:
The frequency and clinical significance of gastroesophageal reflux (GER) in patients after percutaneous endoscopic gastrostomy (PEG) was determined. Ten children, aged 11 months to 15 years, who had normal preoperative extended esophageal pH monitoring were restudied after PEG. Of the ten patients, six developed GER with a pH score significantly higher than their initial one (40.5 +/- 3.3 pre-PEG v 129.5 +/- 24.2 post-PEG, P less than .005). Similarly, the mean post-PEG pH score was higher in patients with GER than in those without a change in score (129.5 +/- 24.2 v 33.8 +/- 2.8, P less than .005). None of these patients was symptomatic for GER immediately after the PEG, but within 10 months of surgery, three of six (50%) developed reflux-related symptoms. These data indicate that clinically significant GER is associated with PEG.