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Gastroesophageal reflux secondary to gastrostomy tube placement
Insights
Children with severe psychomotor retardation may develop gastroesophageal reflux (GER) after gastrostomy tube placement. Continuous tube feeding can reduce vomiting and improve weight gain, aiding subsequent antireflux surgery.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
Background:
- Gastrostomy tubes are used for nutritional support in children with severe psychomotor retardation.
- Some children develop vomiting and poor weight gain post-gastrostomy tube placement, with unclear etiology.
- Pre-operative pH probe testing may not always identify significant gastroesophageal reflux (GER).
Purpose of the Study:
- To investigate the development of symptomatic GER in children following gastrostomy tube placement.
- To evaluate the efficacy of continuous gastrostomy tube feeding in managing GER-related symptoms.
- To assess the impact of continuous feeding on nutritional status prior to potential antireflux surgery.
Main Methods:
- Evaluation of five children with severe psychomotor retardation and post-gastrostomy tube feeding issues.
- Pre- and post-treatment esophageal manometrics and 24-hour pH probe testing.
- Assessment of vomiting frequency and weight gain over a 12-month period.
Main Results:
- Continuous 12-hour gastrostomy tube feeding significantly reduced vomiting in all patients.
- All patients achieved substantial weight gain (mean 44.0%) after one year of continuous feeding.
- Esophageal manometrics and pH testing confirmed low lower esophageal sphincter pressure and significant GER.
Conclusions:
- Gastrostomy tube placement can precipitate symptomatic GER in susceptible children.
- Continuous gastrostomy tube feeding is an effective conservative management strategy for vomiting and poor weight gain.
- Improved nutritional status from continuous feeding facilitates subsequent antireflux surgery.
Abstract:
We evaluated five children with severe psychomotor retardation who developed frequent vomiting and poor weight gain after surgical placement of a feeding gastrostomy tube. Prolonged pH probe testing before surgery did not reveal notable gastroesophageal reflux (GER). Treatment with 12-hour gastrostomy tube feeding resulted in a marked reduction in vomiting; after one year of continuous feeding, all patients had achieved significant weight gain (mean, 44.0%). Esophageal manometrics and 24-hour pH probe testing before and at the end of the 12-month continuous-feeding period demonstrated low pressures of the lower esophageal sphincter and significant GER in the five children studied. These results indicate that children may develop symptomatic GER after gastrostomy tube placement. In such patients continuous gastrostomy tube feeding may result in a cessation of vomiting and achievement of significant weight gain. Definitive antireflux surgery can then be performed with the patient in an improved nutritional state.