Gastroesophageal reflux disease in children

Area of Science:

• Pediatric Surgery
• Gastroenterology

Background:

• Decisions regarding treatment for gastroesophageal reflux disease (GERD) are complex.
• Distinguishing physiologic from pathologic reflux and correlating reflux measures with symptoms are significant challenges.
• Outcomes of antireflux procedures, particularly fundoplications, are not well-defined.

Purpose of the Study:

• To clarify the current understanding and uncertainties surrounding pediatric gastroesophageal reflux disease (GERD).
• To review the most recent evidence regarding antireflux procedures and their indications.
• To aid surgeons in providing guidance to patients and families despite evidence gaps.

Main Methods:

• Review of recent literature on pediatric gastroesophageal reflux disease (GERD) and antireflux surgery.
• Analysis of factors contributing to treatment challenges and variability in procedure utilization.
• Synthesis of existing data to define knowns and unknowns in the field.

Main Results:

• Significant variability exists in the utilization of pediatric antireflux procedures across the United States.
• High-quality data supporting specific indications for fundoplication in children is often lacking.
• Retrospective studies and anecdotal evidence offer some support for fundoplication in select cases.

Conclusions:

• Further high-quality research is essential to improve evidence-based recommendations for pediatric antireflux surgery.
• Surgeons must balance current uncertainties with the need to provide timely guidance for gastroesophageal reflux disease (GERD) management.
• Clarifying the distinction between physiologic and pathologic reflux and improving outcome characterization are critical next steps.