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Gastroesophageal reflux in infants with hydrocephalus before and after ventriculo-peritoneal shunt operation
E Shteyer1, E Rothman, S Constantini
1Department of Pediatrics, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Insights
Gastroesophageal reflux (GER) is common in neurologically impaired children. This study suggests increased intracranial pressure (ICP) may cause GER in infants, particularly those with hydrocephalus and Arnold-Chiari malformation.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Neurology
- Neurosurgery
Background:
- Gastroesophageal reflux (GER) is prevalent in neurologically impaired children.
- The etiology of GER in this population remains unclear.
- Animal studies link elevated intracranial pressure (ICP) to decreased lower esophageal sphincter pressure.
Purpose of the Study:
- To investigate the association between increased ICP and GER in infants with hydrocephalus.
- To evaluate the effect of ventriculoperitoneal (V-P) shunt surgery on GER.
Main Methods:
- Esophageal pH monitoring was performed on ten infants with hydrocephalus before and after V-P shunt placement.
- Data analysis focused on reflux parameters and scoring.
Main Results:
- Five out of ten infants exhibited significant GER prior to surgery.
- Two infants showed normalization of reflux post-surgery.
- The remaining three infants demonstrated reduced GER, indicated by improved pH monitoring parameters.
Conclusions:
- Increased ICP in infants is associated with GER.
- A potential causal relationship between elevated ICP from fourth ventricle floor defects (e.g., Arnold-Chiari malformation) and GER is suggested.
Abstract:
Gastroesophageal reflux (GER) is common in neurologically impaired children, especially those with central nervous system disorders. The cause of GER in these children has not yet been defined, but in animal studies, acute elevation of intracranial pressure (ICP) has been shown to result in a decrease in lower esophageal sphincter pressure. Ten infants with hydrocephalus underwent esophageal pH monitoring prior to and after a ventriculoperitoneal (V-P) shunt operation. A significant degree of reflux was present in 5 patients with hydrocephalus prior to shunt operation and reverted to normal in 2. In the other 3 infants, the degree of reflux decreased as evidenced by fewer abnormal parameters and lower scoring in each of the parameters measured. Our study supports the contention that increased ICP in infants is indeed associated with GER. As 4 of the 5 infants with significant reflux suffered from an Arnold-Chiari malformation, a causal relation between increased ICP due to defects involving the fourth ventricle floor and GER is suggested.