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[Gastroesophageal reflux in children: analysis of 34 consecutive cases]
Insights
Gastroesophageal reflux (GER) in children often leads to esophageal stenosis and Barrett's esophagus, indicating delayed diagnosis or inadequate treatment. A less invasive surgical approach, gastro-fundoplication, offers good results with fewer complications for these cases.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Surgery
- Gastrointestinal Motility Disorders
Context:
- Gastroesophageal reflux (GER) is common in children, often associated with hiatal hernias.
- Delayed diagnosis or suboptimal medical management of GER can lead to severe esophageal complications.
- Esophageal stenosis and Barrett's esophagus are significant concerns in pediatric GER cases.
Purpose:
- To evaluate the incidence of esophageal stenosis and Barrett's esophagus in children with GER.
- To assess the effectiveness and safety of surgical interventions for GER-related esophageal complications.
- To compare intrathoracic Nissen fundoplication with a less invasive gastro-fundoplication approach.
Summary:
- A study of 34 children (6 months to 10 years) with GER revealed a high incidence (80%) of esophageal stenosis.
- Of those with stenosis, 70% developed shortened or Barrett's esophagus, suggesting delayed diagnosis or treatment.
- Surgical Nissen fundoplication is the standard treatment; a modified gastro-fundoplication without thoracotomy is presented as a safer alternative with good outcomes.
Impact:
- Highlights the critical need for timely GER diagnosis and effective treatment in children.
- Introduces a less invasive surgical technique for managing complex GER cases, potentially reducing surgical risks.
- Emphasizes the long-term esophageal consequences of untreated or undertreated pediatric GER.
Abstract:
We studied 34 consecutive children from 6 m to 10 yr presenting gastroesophageal reflux (GER) with or without hiatal hernia. There was a high incidence of stenosis: 28 (80%) children presented with stenosis of the esophagus from mild to severe degree and 20 of them (70%) developed shortened or Barrett's esophagus. This data suggest that in our serie the diagnosis of GER has been delayed or medical therapy has been inadequate or excessively prolonged. The surgical treatment of GER with or without stenosis is the Nissen fundoplication. Our first cases of shortened esophagus were treated by intrathoracic Nissen fundoplication, which was considered an extensive and major risk surgery. Lately, for these cases we have been utilizing the gastro-fundoplication without opening of the chest. This is an easier surgery, through which we could reach good results without serious postoperative complications.