Symptomatic gastroesophageal reflux following gastrostomy in neurologically impaired patients

Utilizing the sequence of contrast radiography, gastric technetium scintigraphy, and 24-hour pH probe, 30 of 46 (65%) neurologically impaired patients, referred for feeding gastrostomy, were demonstrated to have gastroesophageal reflux and underwent a Nissen fundoplication and gastrostomy. There was no evidence of reflux in the remaining 16 (35%) and a gastrostomy alone was performed. Four infants (aged 2 to 13 months) subsequently developed progressive vomiting from 2 to 8 months following gastrostomy placement. Repeat evaluation documented postoperative reflux in three. All four underwent a Nissen fundoplication with relief of their symptoms. Gastroesophageal reflux following gastrostomy may have been produced by an alteration in anatomy or progressive neurologic dysfunction. In all likelihood, however, it was present but undetected preoperatively. An antireflux procedure was required following gastrostomy in 25% of neurologically impaired patients with an initial negative reflux evaluation. Additionally, primary fundoplication in this group was associated with 10% incidence of recurrent symptoms. The high incidence of postoperative reflux, as well as the morbidity associated with gastrostomy in face of gastroesophageal reflux, warrants careful follow-up of the brain damaged patient with feeding gastrostomy.