Antireflux Procedures for Gastroesophageal Reflux Disease in Children

Abstract

Of the 141,190 patients meeting study criteria, 11,621 (8.2%) underwent ARPs during the study period. More than half of patients undergoing ARPs (52.7%) were 6 months or younger. Although most patients in the ARP group had preoperative upper gastrointestinal tract fluoroscopy (65.0%), these patients did not undergo a uniform workup. The hazard of progression to an ARP was significantly decreased in children aged 7 months to 4 years (hazard ratio, 0.63 [P < .001]) and 5 to 17 years (0.43 [P < .001]) relative to children younger than 2 months. Hazard ratios were independently increased for comorbid diagnoses of failure to thrive, neurodevelopmental delay, cardiopulmonary anomalies, cerebral palsy, and aspiration pneumonia and among patients with tracheoesophageal fistula and diaphragmatic hernia. Each additional GERD-related hospitalization was associated with a 10% increased risk of an ARP. CONCLUSIONS AND REVELANCE: Antireflux procedures are most commonly performed in children during a period of life when regurgitation is normal and physiologic and objective measures of GERD are difficult to interpret. To identify meaningful outcomes after ARP, indications must be clear and standardized. We must clarify the appropriate workup for infants and young children with GERD and better define "failure of medical management" in this population.

Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients

“…The great majority of the fundoplications and all esophagogastric disconnections were performed in children with significant associated disorders. Based on their cohort of over 11,000 patients, McAteer et al (11) recently criticized the excessive use of surgical treatment of GER in healthy infants aged below 6 months in whom GER is physiological. Our management of GER in healthy infants has been very conservative.…”

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

“…Two prior larger retrospective patient population studies, based on hospital billing code data, have previously assessed patients requiring anti‐reflux procedures and those undergoing GT tube placement versus those having a GT with concomitant fundoplication; in these studies, the frequency of preoperative 24‐hour pH monitoring and gastric emptying studies being performed were higher than our retrospective cohort, but unfortunately, due to the limitations of billing data, the frequency of abnormal test results for our study were unknown but again may be worth further investigation (20,22).…”

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

“…In general, experience seems to be the best guidance for choosing the technique. Antireflux procedures in the USA were reported to be most commonly performed in children during a period of life when regurgitation is normal and physiologic and objective measures of GERD are difficult to interpret [236]. In contrast, in Europe, antireflux surgery is considered as a treatment of last resort in children with GERD refractory to pharmacological therapies [237].…”