Related Experiment Videos
Patterns of pediatric gastroesophageal reflux
Insights
Surgical management of pediatric gastroesophageal reflux (GER) is effective for infants and children with severe symptoms like vomiting and respiratory issues. Fundoplication offers significant benefits, outweighing the minimal complications in carefully selected patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux (GER) presents differently in pediatric patients compared to adults.
- Infants and children may exhibit respiratory problems, vomiting, or failure to thrive (FTT) due to GER.
- GER often co-occurs with other medical conditions, necessitating consideration in complex pediatric cases.
Purpose of the Study:
- To evaluate the surgical management of GER in pediatric patients.
- To analyze patient presentations and associated conditions.
- To assess the efficacy and outcomes of fundoplication for severe GER.
Main Methods:
- Retrospective review of 38 pediatric patients surgically managed for GER between 1977-1983.
- Categorization of patients based on presentation patterns and associated problems.
- Analysis of fundoplication outcomes in various subgroups, including premature infants with bronchopulmonary dysplasia (BPD), patients with prior esophageal atresia repair, and those with neurologic dysfunction.
Main Results:
- Fundoplication was performed on 38 pediatric patients with GER.
- Patient groups included premature infants with BPD, those with repaired esophageal atresia, and those with neurologic conditions.
- The majority of patients experienced significant improvement, with benefits of surgery outweighing complications in carefully selected cases.
Conclusions:
- Surgical intervention, specifically fundoplication, is a highly successful treatment for carefully selected pediatric patients with severe GER.
- The procedure demonstrates significant benefits for infants and children suffering from debilitating GER-related symptoms.
- Fundoplication offers a favorable risk-benefit profile for managing complex pediatric GER cases.
Abstract:
Gastroesophageal reflux (GER) in the pediatric patient is a frequently recognized problem. Unlike the adult, in whom symptoms relating to esophagitis predominate, the infant and child may present with a variety of respiratory problems, vomiting and/or growth failure. GER is often seen in association with other conditions and must be considered in the evaluation of any pediatric patient with chronic recurring respiratory problems, vomiting or failure to thrive (FTT). Thirty-eight pediatric patients have been surgically managed at West Virginia University from 1977-1983 for GER. The patients fall into several different patterns of presentation and associated problems. Nine premature infants all with bronchopulmonary dysplasia (BPD) have undergone fundoplication for FTT, worsening BPD, and pneumonia. Seven infants and two older children had GER associated with previous esophageal atresia repairs. Esophagitis, vomiting and growth failure were the predominant complaints in this group, though all nine patients had recurring respiratory symptoms as well. Syndromes involving mental retardation and neurologic dysfunction affected another group of five patients, all of whom presented with the complications of long-term esophagitis. The remaining 15 children were otherwise healthy infants who had predominantly respiratory symptoms due to GER. The benefits of fundoplication in these severely affected infants and children far outweigh the relatively few complications. In the carefully selected patient, surgical management of GER is dramatically successful.