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Gastroesophageal reflux in infants and children. Recognition and treatment
Insights
Gastroesophageal reflux in children often resolves with time, but surgery may be needed for severe complications. Nissen fundoplication is effective, but loose construction minimizes side effects.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux is prevalent in infants and children, presenting diverse symptoms.
- Most pediatric reflux cases resolve nonoperatively due to maturing antireflux mechanisms.
Purpose of the Study:
- To outline indications for surgical intervention in pediatric gastroesophageal reflux.
- To discuss the efficacy and potential complications of antireflux surgery.
Main Methods:
- Review of clinical experience with pediatric gastroesophageal reflux.
- Correlation of respiratory symptoms with reflux using 24-hour esophageal pH monitoring.
- Evaluation of Nissen fundoplication as an antireflux procedure.
Main Results:
- Surgical intervention is indicated for reflux complications unresponsive to a six-week medical trial.
- Children with stricture or reflux-related apnea require prompt surgery.
- Loose Nissen fundoplication minimizes dysphagia and gas bloating.
- 24-hour esophageal pH monitoring aids in correlating respiratory symptoms with reflux.
Conclusions:
- Antireflux surgery is reserved for complicated pediatric reflux cases.
- Nissen fundoplication is a reliable procedure when performed correctly.
- Associated medical conditions in the reflux population contribute to inevitable morbidity and mortality.
Abstract:
Gastroesophageal reflux is common in infants and children and is associated with a broad spectrum of symptoms and disease. The majority of young patients with reflux can be managed nonoperatively because growth and time usually bring maturation of the antireflux mechanisms. We feel that operation is justified and indicated for the child with complications of reflux that are not reversed by a six-week medical trial, and children with stricture or infants with reflux-related apnea should have operation without delay. In our experience, analysis of the 24-hour esophageal pH tracing has proved most useful to correlate respiratory symptoms with reflux. The Nissen fundoplication is the most effective and the most reliable antireflux procedure, but it must be constructed loosely to minimize the side effects of dysphagia and gas bloating. Because the population at risk for reflux disease has approximately a 50 per cent incidence of significant associated medical problems, morbidity and mortality from some of these problems is inevitable. There should be little or no mortality associated with the antireflux operation itself.