Surgical Treatment of Gastroesophageal Reflux in Children-Reply

Abstract

In Reply. —Dr Newman raises some important questions regarding the diagnosis and treatment of GER. It is of interest that thickened feedings delay gastric emptying in infants, which in theory may increase reflux. However, the fact is that thickened feedings decrease reflux. This has been noted empirically for 20 years, but also can be measured. In a recent study of 34 infants with GER who underwent a 24-hour pH probe monitoring, 1 we showed that two thirds of these patients had significantly fewer episodes of reflux when feedings were thickened than when they were not. When nonthickened feedings were given to these same patients, episodes of reflux were 50% more frequent than when feedings were thickened. The same study also showed that the prone position was better than the use of the upright position in many patients. However, for most patients, positioning in the chair adequately controls reflux and is