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Management of gastro-oesophageal reflux

I J Carré

    Archives of Disease in Childhood
    |January 1, 1985
    PubMed

    Insights

    Infants with gastro-oesophageal reflux (GER) due to hiatal hernia often improve with conservative treatments like postural therapy. Surgery is reserved for severe or unresponsive cases, with fundoplication being a preferred antireflux operation.

    Area of Science:

    • Pediatric Gastroenterology
    • Surgical Gastroenterology

    Background:

    • Gastro-oesophageal reflux (GER) is common in infants.
    • Hiatal hernias can cause or exacerbate GER.
    • Conservative management is often effective.

    Purpose of the Study:

    • To outline management strategies for infant GER associated with hiatal hernias.
    • To differentiate treatment approaches based on hernia severity and complications.

    Main Methods:

    • Review of conservative management options including postural therapy, thickened feeds, and medications (antacids, domperidone, cimetidine).
    • Indications for surgical intervention, specifically antireflux surgery (Belsey MK IV fundoplication).
    • Management of complicated cases, including strictures and post-atresia repair reflux.

    Main Results:

    • Conservative management is effective for uncomplicated hiatal hernias.
    • Surgical antireflux procedures are indicated for refractory cases or severe hernias.
    • Esophageal dilatations may be needed for strictures.

    Conclusions:

    • Most infant GER with hiatal hernia resolves with conservative care.
    • Antireflux surgery is safe and effective for complicated or severe cases.
    • Surgical intervention is typically reserved for infants over 12 months unless severe.

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