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Management of severe gastroesophageal reflux in children
Insights
Fundoplication surgery effectively treated gastroesophageal reflux in 87% of pediatric patients. Advanced diagnostics may improve patient selection for surgical intervention in reflux cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) causes significant morbidity in children.
- Surgical intervention is considered for severe GER cases unresponsive to medical management.
Purpose of the Study:
- To evaluate the effectiveness of fundoplication in treating pediatric patients with gastroesophageal reflux.
- To identify factors associated with treatment failure.
Main Methods:
- Retrospective review of clinical outcomes for 66 pediatric patients undergoing fundoplication.
- Preoperative confirmation of significant GER using cinefluoroscopic reflux esophagogram or reflux nuclear scan.
Main Results:
- Fundoplication was effective in 87% (56/64) of patients.
- Operative failures were associated with concurrent apnea or recurrent pneumonia.
- No failures exhibited persistent GER post-surgery.
Conclusions:
- Fundoplication is an effective surgical treatment for pediatric gastroesophageal reflux.
- Consideration of advanced diagnostic tests like pH monitoring may enhance patient selection, particularly for those with apnea or pneumonia.
- Accurate diagnosis is crucial for successful surgical outcomes in pediatric GER.
Abstract:
To evaluate response to fundoplication, clinical results for 66 consecutive pediatric patients operated on for gastroesophageal reflux were retrospectively reviewed. Indications for operation were gastroesophageal reflux with apnea, repeated emesis, recurrent pneumonia, failure to thrive, stricture, and esophagitis. All patients had preoperative documentation of significant gastroesophageal reflux by either cinefluoroscopic reflux esophagogram or reflux nuclear scan. Fundoplication was effective in 56 (87%) of 64 patients. None of the patients considered to be operative failures had persistent gastroesophageal reflux. Operative failures occurred primarily in patients with gastroesophageal reflux and apnea or recurrent pneumonia. More advanced diagnostic tests, such as pH monitoring, may help to select patients whose symptoms of apnea and recurrent pneumonia are truly due to reflux. Gastroesophageal reflux produces significant morbidity in pediatric patients and is well treated operatively by fundoplication.