Gastroesophageal reflux in children with neurological impairment: a systematic review and meta-analysis

Lauriti, Giuseppe; Lisi, Gabriele; Chiesa, Pierluigi Lelli; Zani, Augusto; Pierro, Agostino

doi:10.1007/s00383-018-4335-0

Cited by 35 publications

(30 citation statements)

References 53 publications

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“…Compared to the available literature [7,12,13], our study tried to shed a light on a controversial topic: the advantage of an ARP to reduce respiratory impairment in the neuropathic child needing gastrostomy. Gastrostomy itself is a contributing factor in the decision for fundoplication in many centers; although open gastrostomy has been demonstrated to promote reflux [14], the minimally invasive techniques have been shown to not exacerbate reflux quantitatively or qualitatively in most children [15].…”

Section: Discussionmentioning

confidence: 99%

“…In this population, nutrition and primary aspiration risks are often tackled with non-oral methods of food delivery, such as naso-gastric tube (NGT) or gastrostomy/gastrojejunostomy (GJ) placement [4], with the latter two being sometimes associated with an anti-reflux procedure (ARP) or even total esophago-gastric dissociation (TOGD) [5,6]. In NI children failure of ARP is reported high as 50% [7]. Although nutritional management is a crucial aspect for these patients, there is no univocal consensus on the approach to be applied [4]: this is mainly due to either lack of measured objective outcomes or to the reduced number of patients enrolled in each report.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

et al. 2021

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Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

et al. 2021

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“…A retrospective analysis of discharge data for 342 pediatric patients, found no difference in hospital admissions for aspiration pneumonia, other pneumonia or respiratory distress before or after anti-reflux surgery ( 100 ). Finally, a meta-analysis by Lauriti et al showed that gastro-jejunal feeding was no better at preventing respiratory complications than anti-reflux surgery in children with NI ( 101 ). Large prospective, high quality trials would be useful to determine if and when treatment of GOR is useful in improving respiratory morbidity.…”

Section: Respiratory Dysfunctionmentioning

confidence: 99%

Multi-Organ Dysfunction in Cerebral Palsy

et al. 2021

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Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.

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“…It is reasonable to counsel families that symptoms typically improve after 1 year of age in the overwhelming majority of healthy infants. GERD does, however, demonstrate an increased prevalence in children affected by: prematurity, obesity, neurological impairment, congenital heart disease, congenital diaphragmatic hernia, gastrointestinal (GI) tract abnormalities, and chromosomal abnormalities (2,(14)(15)(16)(17)(18)(19)(20)(21). Refractory GERD refers to GERD symptoms that do not respond to medical treatment after 8 weeks (10).…”

Section: Epidemiology Pathogenesis and Presentationmentioning

confidence: 99%

A narrative review of gastroesophageal reflux in the pediatric patient

Jacobson¹,

Pandya²

2021

Transl Gastroenterol Hepatol

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Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus.It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms.While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H 2 -antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER.In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.

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Gastroesophageal reflux in children with neurological impairment: a systematic review and meta-analysis

Cited by 35 publications

References 53 publications

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

Multi-Organ Dysfunction in Cerebral Palsy

A narrative review of gastroesophageal reflux in the pediatric patient

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