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[Gastroesophageal reflux in childhood]
Insights
Gastro-oesophageal reflux in children often causes vomiting and failure to thrive, but two-thirds improve with conservative treatment. Surgery is reserved for severe cases, with specific procedures preferred over Nissen
Area of Science:
- Pediatric Gastroenterology
- Surgical Pediatrics
Background:
- Gastro-oesophageal reflux (GOR) in infants and children can lead to serious complications like aspiration pneumonia and failure to thrive.
- While many cases resolve with conservative management, a significant portion requires surgical intervention.
- The etiology of GOR in children is diverse, with primary and secondary causes, including those associated with cerebral palsy and post-operative conditions.
Purpose of the Study:
- To review the management of gastro-oesophageal reflux in pediatric patients.
- To differentiate between conservative and surgical treatment indications.
- To evaluate surgical approaches for pediatric GOR.
Main Methods:
- Review of current knowledge on the pathophysiology and etiology of pediatric GOR.
- Analysis of criteria for surgical intervention, emphasizing clinical outcomes over radiographic findings.
- Comparison of surgical techniques, including Nissen fundoplication and alternative reconstructions.
Main Results:
- Two-thirds of pediatric GOR cases are successfully managed conservatively.
- Surgical intervention is indicated for persistent symptoms or complications such as esophagitis, stenosis, anemia, and aspiration pneumonia.
- Nissen fundoplication is associated with high morbidity in children; alternative reconstructions are suggested for uncomplicated cases.
Conclusions:
- Conservative management is effective for a majority of pediatric GOR cases.
- Surgical indications are primarily based on clinical evidence of complications rather than imaging.
- Reconstructive surgery, focusing on the angle of His and abdominal esophagus repositioning, is preferred over Nissen fundoplication for uncomplicated pediatric GOR.
Abstract:
1. Gastro-oesophageal reflux of infancy and childhood leads to vomiting and frequently to aspiration pneumonia and failure to thrive. 2. Two thirds of all cases can be cured conservatively. One third has to undergo surgery. 3. According to our present knowledge, the mechanism of the cardia seems to be competent at birth, however, peristaltism and reflex activity undergoes a maturation process. 4. The aetiology of gastro-oesophageal reflux in childhood is variable. There is a distinct difference between primary and secondary reflux. The latter occurs in children with cerebral palsy as well as following operations of the oesophagus or the hiatus. 5. The indication for an operative intervention is not as much depending upon the radiographic findings as upon the existence of oesophagitis, stenosis, anemia and aspiration pneumonia. 6. Nissen's fundoplication is not the operation of choice in childhood since this intervention is followed by a high morbidity. For uncomplicated cases, reconstruction of the angle of His and repositioning of the abdominal oesophagus into the abdominal cavity in combination with a semiplication of the fundus is preferable.