Gastroesophageal Reflux Disease In Children Research Articles

Utility of the Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes in Children.

(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5-18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients.

Guidelines for evaluation and treatment of gastroesophageal reflux disease in children – Recommendations of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Guidelines for evaluation and treatment of gastroesophageal reflux disease in children – Recommendations of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association

Antireflux Procedures in Children With Neurologic Impairment: A National Survey of Physician Perspectives.

Decision-making about antireflux procedures (ARPs) to treat gastroesophageal reflux disease in children with neurologic impairment and gastrostomy tubes is challenging and likely influenced by physicians' experience and perspectives. This study will explore physician attitudes about ARPs and determine if there are relationships to clinical practice and personal characteristics. This is a national observational cross-sectional study that used an electronic questionnaire addressing reported practice, attitudes regarding the ARPs, and responses to clinical vignettes. Participants were physicians in Canadian tertiary-care pediatric settings. Descriptive statistics were used to analyze physician attitudes. Multivariable logistic regression modeling was used to determine associations between physician and practice characteristics and likelihood to consider ARP. Eighty three respondents represented 12 institutions, with a majority from general or complex care pediatrics. There was a wide disparity between likelihood to consider ARP in each clinical scenario. Likelihood to consider ARP ranged from to 19% to 78% depending on the scenario. Two scenarios were equally split in whether the respondent would offer an ARP. None of the demographic characteristics were significantly associated with likelihood to consider ARP. Often, gastrojejunostomy tubes alone were considered (56% to 68%). There is considerable variability in physician attitudes toward and recommendations regarding ARPs to treat gastroesophageal reflux disease. We did not find a significant association with clinical experience or location of practice. More research is needed to define indications and outcomes for ARPs. This is a scenario where shared decision-making, bringing together physician and family knowledge and expertise, is likely the best course of action.

The Dental Implications of Gastro-oesophageal Reflux Disease in Children

Gastro-oesophageal reflux disease (GORD) is common in children and has numerous extra-oesophageal manifestations which dental practitioners should be aware of. This article illustrates the role of the dentist in recognizing the signs and symptoms of GORD in children. A risk-based management system is illustrated to guide clinicians in managing children exhibiting erosive tooth wear. CPD/Clinical Relevance: Dental implications of GORD in children and its management provide useful clinical information for dental practitioners.

Modern strategy for management of pediatric patients with gastroesophageal reflux disease in compliance with the international and national guidelines

Recent epidemiological studies demonstrated that gastroesophageal reflux disease (GERD) takes a leading place among acid‑dependent gastroenterological diseases. The problems of GERD development prevention and its treatment are topical since GERD significantly reduces the quality of life, especially when extraesophageal symptoms appear. Timely and correct GERD diagnosis, treatment and monitoring in pediatric patients prevents the development of complicated course of the disease in adults. Last decade, priority attention has been given to improving the quality of medical care in most countries worldwide. To achieve this purpose, effective medical care should be provided and the results of treatment of patients should be improved.
 The review presents analysis of current strategies for GERD diagnosis and treatment in pediatric patients based on the international and national guidelines. To ensure the proper quality of medical care, it is necessary to standardize approaches to diagnosis and treatment of diseases in childhood. The preparation of the Medical Standards of Care «Gastroesophageal Reflux Disease in Children» by a multidisciplinary group of experts and the adaptation of the clinical guideline are purposed to the improvement of existing diagnostic and treatment approaches to GERD pediatric patients in Ukraine, to ensuring high‑quality and effective medical care and establishing the uniform requirements for prevention, diagnosis and treatment of this group of patients. The results of modern investigations, based on international consensuses on the GERD diagnosis and treatment in childhood, have been highlighted. The latest information on the expediency of administration of instrumental examinations and treatment tactics has been presented.

Modern trends in the formation of comorbid pathology of the esophagus and gastroduodenal zone in children

The article presents modern views on trends and controversial issues in the formation of combined pathology of the gastroduodenal zone and esophagus in children. The purpose of the authors of this study: to identify the features of the formation, course and outcomes of gastroesophageal reflux disease (GERD) in children with pathology of the gastroduodenal zone (GDZ) based on endoscopic and morphological comparisons. Own long-term observations were analyzed depending on the type of pathology, the severity of motor disorders, endoscopic and morphological picture, infection Helicobacter pylori. Possible options for the formation of gastroesophageal reflux disease in children and adolescents with various diseases of the gastroduodenal zone were determined. It has been established that the combined nature of the pathology of the esophagus and gastroduodenal zone in children occurs in more than 75% of patients. The nature and severity of esophageal disorders depend on the nature of the nosology of the gastroduodenal zone and, as a rule, are secondary. The increase in the frequency of GERD in modern children, the increase in the proportion of its complicated variants (including ulcers and Barrett's esophagus), make it a priority in the study of diseases of the upper digestive tract in children at the present time. For this contingent of young patients, it is urgent and urgent to develop clear diagnostic criteria (including endoscopic and morphological criteria), therapy tactics, and a strategy for cancer prevention.

The role of stress factors in the formation of gastroesophageal reflux disease in children: characteristics of anxiety-phobic and depressive disorders

Introduction. There is enough evidence of the influence of the psycho-emotional state of children on the development of gas-troesophageal reflux disease, numerous studies reveal anxiety and depressive disorders in them. However, there is no common understanding of the specific causal relationships underlying the pathogenesis of this disease.Aim. To identify the features and possible causes of anxiety and depressive disorders in children with gastroesophageal reflux disease and analyze their role using Yu.I. Burlan's system-vector psychology.Materials and methods. 677 adolescents aged 11-17 years were examined on the basis of the pediatric department in the Clinic of the Research Institute of Medical Problems of the North (Krasnoyarsk). The gastroesophageal reflux diseasewas diagnosed by testing according to the Russian version of the Gastroesophageal Reflux Disease Questionnaire. Computerized testing “The Development and Well-Being Assessment” was used to identify mental disorders.Results. In children with gastroesophageal reflux disease, all kinds of fears were significantly more common: fear of separation - 50.0 (25.1-74.9)%; darkness, thunderstorms, thunder, heights - 66.7 (38.6-86.1)%; blood injections, wounds - 58.3 (31.6-80.8)%; loud noise - 33.3 (13.9-61.4)%; to be far from home - 41.7 (19.2-68.4)%. 41.7 (19.2-68.4)% of children had manifestations of depression, which is 2 times more often than in the control group, and every fourth had self-harm. Separation from friends, panic attacks, fear of death, melancholy, resentment, learning problems, appearance were indicated as the causes of depression.Conclusions. The causal relationships disclosed by the system-vector psychology, according to which certain stress factors play an important role in the development of gastroesophageal reflux disease. These factors depend on the type of character: for emotional children, these are all kinds of fears, phobias, breaking emotional ties, problems in relationships with others, and for obedient and calm children - resentment, learning problems and any factor of novelty (change of the usual environment, living conditions, team).

Esophagoprotective agent in the treatment of gastroesophageal reflux disease in children

Gastroesophageal reflux disease (GERD) prevalence in children and adolescents is estimated as high. GERD has a wide variety of clinical signs that significantly reduce the patients' quality of life. Typical symptoms include heartburn, belching, and regurgitation (regurgitation). Extraesophageal symptoms are mainly represented by complaints indicating the involvement of the respiratory, ENT organs, and oral cavity organs in the process. In addition, gastroesophageal reflux disease is a major risk factor for Barrett's esophagus and esophageal adenocarcinoma. The main factors predisposing to the development of gastroesophageal reflux disease in children are obesity, overeating, congenital anomalies of the esophagus, surgical interventions at the cardioesophageal junction, immature autonomic nervous system, nervous system diseases, administration of certain drugs, as well as vices such as smoking and alcohol drinking in adolescence. The mainstay of treatment of gastroesophageal reflux disease is antisecretory therapy with proton pump inhibitors. However, some patients using proton pump inhibitors at a standard dosage fail to achieve the clinical and endoscopic remission of the disease. The causes of the gastroesophageal reflux disease refractoriness to the adequate therapy most often include impaired barrier function and increased esophageal mucosal permeability. The use of esophagogastroprotective agents contributes to the optimization of therapy of gastroesophageal reflux disease and aims at achieving the disease remission in a larger number of patients. Clinical case reports of diagnosis and treatment of patients aged 12 and 16 years with gastroesophageal reflux disease are presented. The use of the esophagoprotective agent provided rapid relief of both esophageal and extraesophageal symptoms of the gastroesophageal reflux disease. In addition, complete healing of erosive esophagitis was achieved during its therapy.

Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study

Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters.The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group (n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices. Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 (P = 0.001) and 0.726 (P = 0.014).The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

Supporting families in the management of gastroesophageal reflux disease in children

Gastroesophageal reflux disease (GERD) in children is a frequent reason for medical consultation. Itis defined as the involuntary passage of gastric contents into the esophagus, with or without regurgitation and vomiting. It can become pathological if it leads to embarrassing symptoms and complications. Often confronted with this pathology, nursery nurses sometimes find themselves at a loss when it comes to treating the symptoms of pathological GERD in a toddler, as well as in supporting the parents. In order to give them some ideas, a review of the literature on the benefits of non-medicinal strategies on regurgitation in full-term infants with pathological GERD was conducted.

Gastroesophageal reflux disease in children: What's new right now?

Gastroesophageal reflux (GER) in children is very common and refers to the involuntary passage of gastric contents into the esophagus. This is often physiological and managed conservatively. In contrast, GER disease (GERD) is a less common pathologic process causing troublesome symptoms, which may need medical management. Apart from abnormal transient relaxations of the lower esophageal sphincter, other factors that play a role in the pathogenesis of GERD include defects in esophageal mucosal defense, impaired esophageal and gastric motility and clearance, as well as anatomical defects of the lower esophageal reflux barrier such as hiatal hernia. The clinical manifestations of GERD in young children are varied and nonspecific prompting the necessity for careful diagnostic evaluation. Management should be targeted to the underlying aetiopathogenesis and to limit complications of GERD. The following review focuses on up-to-date information regarding of the pathogenesis, diagnostic evaluation and management of GERD in children.

Comparative study of laparoscopic Nissen fundoplication versus Hill-Snow procedure for the treatment of gastroesophageal reflux disease in children: a single-blinded randomized controlled trial

BackgroundGastroesophageal reflux disease (GERD) is a common condition in children. Complete fundoplication provides better reflux control but it results in more dysphagia and gas-bloat symptoms. Antireflux surgery without wrap has fewer adverse effects but a higher failure rate in controlling reflux. Until now, there is little evidence as to whether complete or partial fundoplication is the optimal procedure in this age group.ObjectiveThis study aimed to compare the safety and efficacy of laparoscopic Nissen fundoplication versus Hill-Snow procedure among children with GERD.MethodsWe conducted a randomized, single-blinded, comparative trial that included 40 children with a diagnosis of GERD, who were scheduled to undergo surgery. Children were randomly allocated to undergo laparoscopic Nissen fundoplication or Hill-Snow procedure.ResultsWhile the incidence of postoperative dysphagia was similar between both groups, the duration of dysphagia was significantly shorter in the Hill-Snow group. Likewise, the incidence of bloating was significantly lower in the Hill-Snow group than the Nissen group (0% versus 55%, respectively). We found three recurrent Hill-Snow cases versus two recurrent Nissen cases. The operative time was significantly longer in the Hill-Snow procedure (150 ± 52 min) than in the Nissen group (120 ± 48 min).ConclusionsThe Hill-Snow procedure is an effective alternative to Nissen fundoplication with no bloating and much less dysphagia, leading to faster recovery of ordinary eating patterns.

Association Between Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire Score, Endoscopy and Biopsy in Children with Clinical Gastroesophageal Reflux Disease: A Prospective Study.

Gastro esophageal reflux disease (GERD) is a burdensome disease affecting many children. A clinical examination is reported to be unreliable to diagnose GERD in children. This study aimed to investigate the relationship between the Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire (PGSQ) and endoscopic and histopathological findings in children with symptoms suggesting GERD. Changes in the PGSQ score in children with esophagitis as response to one month therapy were recorded as secondary outcome. This is a prospective cohort study in the pediatric outpatient clinic in an Indonesian tertiary hospital. Children aged 2-17 years old with clinical symptoms suspected of GERD are included in the study. Blinded endoscopic and histopathological examination was performed in all patients before one month proton pump inhibitors (PPI) therapy. The PGSQ information was collected at inclusion and after one month PPI treatment. Fifty-eight subjects were included. Esophagitis was found in 60.9% of subjects according to endoscopy and 58.6% according to histology. There was no significant relationship between the PGSQ score and endoscopic (p=0.781) nor biopsy (p=0.740) examinations. The PGSQ showed a low diagnostic value compared to endoscopy and biopsy (area under the curve [AUC] 0.477, p=0.477, 95% confidence interval [CI] 0.326-0.629 and AUC 0.474, p=0.740 (95% CI 0.321-0.627 respectively). The PGSQ improved significantly post one month of PPI treatment. The PGSQ cannot be used to diagnose esophagitis in children with clinical symptoms suggesting GERD. However, the PGSQ can be used to monitor the treatment response in children with esophagitis.

Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis

ObjectiveTo assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. MethodsAn analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. ResultsA total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. ConclusionsThe prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.

СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНИ У ДЕТЕЙ: КЛИНИКА, ДИАГНОСТИКА И ЛЕЧЕНИЕ (ЧАСТЬ 2)

The bibliographical review is dedicated to the modern views on the clinical picture, methods of diagnosis and surgical treatment of the gastroesophageal reflux disease in children. The authors performed the analysis of the latest scientific publications by Russian-speaking and foreign authors devoted to the evolution of molecular genetic and cytogenetic sampling, the role of morphological and immunohistochemical sampling in the diagnosis of pathology; examined the authors’ opinions on the timing and tactics of surgical intervention as well as the advantages of minimally invasive surgery. Part 1 of the review is available at: N.N. Akhparov, R.Z. Boranbaeva, S.B. Suleimanova, L.N. Manzhuova. Modern views on gastroesophageal reflux disease in children: issues of classification, etiology and pathogenesis (Part I). Pediatria n.a. G.N. Speransky. 2021; 100 (6): 85-91. DOI: 10.24110/0031-403X-2021-100-6-85-91. https://doi.org/10.24110/0031-403X-2021-100-6-85-91.

Diagnostic value and application of 24 h multichannel intraluminal impedance-pH monitoring in children with gastroesophageal reflux disease

Objective: To evaluate the diagnostic value and application of 24 h multichannel intraluminal impedance-pH (24 h MII-pH) monitoring in children with gastroesophageal reflux disease (GERD). Methods: This is a cross-sectional study. From January 2013 to December, 2020, 417 patients who received 24 h MII-pH monitoring in Department of Gastroenterology of Children's Hospital Capital Institute of Pediatrics were included. According to results, these children were divided into the GERD and non-GERD groups. Furthermore, the 132 children with GERD who had gastroscopy were divided into the reflux esophagitis (RE) and non-erosive reflux disease (NE) groups to investigate the differences in their refluxes. Non-parametric Mann-Whitney U test or indepentent sample t test was used for comparisons between the groups. Results: Among the 417 children, 232 were males and 185 females, aged (7.3±3.9) years. The course of disease was 0.5 (0.1, 2.0) years. The main clinical symptoms included acid reflux (128 cases), vomiting (173 cases), abdominal pain (101 cases), and cough (76 cases). The 24 h MII-pH monitoring were positive in 243 children (58.3%, 243/417), which was higher than that by 24 h esophageal pH monitoring (43.6%, 182/417). The 24 h MII-pH monitoring results demonstrated significant differences in the episodes of acid reflux, weakly acidic reflux, non-acidic reflux, liquid reflux and mixed reflux between GERD and non-GERD groups (10 (4, 19) vs. 4 (1, 9) times/24 h, 14 (6, 32) vs. 7 (3, 13) times/24 h, 0 (0, 0) vs. 0 (0, 0) times/24 h, 19 (10, 34) vs. 8 (3, 14) times/24 h, and 6 (2, 12) vs. 3 (1, 5) times/24 h, Z=-6.96, -7.25, -5.62, -8.75, and -6.48, all P<0.05, respectively). Besides, the results also showed significant differences in Boix-Ochoa score, episodes of long reflux, course of long reflux, and episodes of weakly acidic reflux between the RE and NE groups (51.2 (21.4, 153.2) vs. 20.7 (12.1, 34.7), 5 (2, 10) vs. 1 (0, 4) times/24 h, 19 (7, 87) vs. 8 (3, 22) min, and 5 (2, 15) vs. 15 (6, 33) times/24 h, Z=-3.44, -3.41, -2.65, and -2.27, all P<0.05, respectively). Conclusion: 24 h MII-pH monitoring not only improves the detection rate of GERD in children, but also provides a possibility to early etiological diagnosis.

56 Gastroesophageal reflux disease in children with neurological impairment: a population-based retrospective cohort study

Abstract Background Children with neurological impairment (NI) are at increased risk of gastroesophageal reflux disease (GERD) and may be more susceptible to complications such as esophagitis and aspiration. Diagnosis is challenging due to communication impairments and frequent comorbidities, such as dysphagia, that present similarly to GERD. There is a risk of both under and over diagnosis with detrimental effects. Prior research has suggested the prevalence of GERD is as high as 75%. However, these studies examined subpopulations such as children presenting with symptoms or living in institutions, often many decades ago. Objectives Our aim was to determine the incidence and prevalence of GERD diagnosis and treatment in children with NI at a population level. Design/Methods This is a retrospective cohort study using provincial administrative data. Children with NI were identified by International Classification of Diseases (ICD-10) codes in the Discharge Abstract Database (DAD) between 2006 and 2018. GERD was defined as: (1) 1+ codes in DAD or National Ambulatory Care Reporting System; (2) 2+ specialist claims; (3) 1+ ASM prescription. Age, gender, complex chronic conditions (CCC) and technology assistance (TA) were covariates. ASM prescriptions and anti-reflux procedures were collected. Descriptive statistics included means with standard deviations and counts with proportions. Univariable and multivariable Poisson regressions calculated incidence rates and rate ratios for the presence of GERD and prescription of ASM. Results Among 10,309 children with NI, 2,772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years. Increasing numbers of CCCs were associated with a higher risk of GERD. Children with four or more CCCs had an incidence almost three times that of children with no CCCs. A gastrostomy tube incurred a five times higher rate of GERD. Overall, 2486 (23.7%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 prescriptions per year. Neonatal, respiratory and congenital CCCs were associated with higher rates of ASM prescribing. The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.3% (n=351). Conclusion The incidence of GERD in children with NI is dramatically higher than in the general pediatric population, as is the use of ASM. Both disparities are heightened in children with gastrostomy tubes, perhaps due to increased severity of NI or relevant comorbidities. Regardless, GERD is clearly a significant clinical issue in this population that warrants additional study to determine optimal diagnosis and treatment practices.

Characteristics of gastroesophageal reflux disease in children with interstitial lung disease.

Childhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes. This was a prospective cross-sectional study. Consecutive patients with chILD underwent 24-h multichannel intraluminal pH-impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis. Sixty-two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (-) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs. 42.0 p = 0.0004), acid GER (35.5 vs. 15.0 p = 0.004), and acid proximal GER (21.0 vs. 12.0 p = 0.02). There were no differences in the number of proximal GER comparing GERD (+) and GERD (-) subgroups. The frequency of GERD seems to be relatively high in the population of children with chILD used in this study. However, it has not demonstrated an association between proximal GER and GERD diagnosis in chILD, which casts uncertainty over the microaspiration theory proposed to link the two diseases. The latter conclusion, however, needs to be confirmed using more accurate aspiration assessment methods.

Impact of previous abdominal surgery on the outcome of fundoplication for medically refractory gastroesophageal reflux disease in children and young adults

Summary Importance Fundoplication (FP) is a well-established surgical treatment for gastroesophageal reflux disease (GERD) refractory to medical therapy in children and young adults. During FP, previous abdominal surgery (PAS) can impair the patient’s outcome by causing technical difficulties and increasing intra- and postoperative complication rates. Objective The aim of this study was to determine the impact of PAS on the short- and long-term outcome following FP for refractory GERD in a cohort of patients aged &lt; 23 years. Methods We retrospectively analyzed 182 patients undergoing a total of 201 FP procedures performed at our university center for pediatric surgery from February 1999 to October 2019. Pre-, intra-, and postoperative variables were recorded and their impact on the rate of intraoperative complications and revision FP (reFP) was analyzed. Results A total of 201 FP procedures were performed on 182 patients: 119 (59.2%) as Thal-FP (180° anterior wrap) and 82 (40.8%) as Nissen-FP (360°circular wrap; 67.2% laparoscopic, 32.8% open, 8.9% conversion). The presence of PAS (95 cases, 47.3%) was associated with significantly longer operative times for FP (153.4 ± 53.7 vs.126.1 ± 56.4 min, p = 0.001) and significantly longer hospital stays (10.0 ± 7.0 vs. 7.0 ± 4.0 days, p &lt; 0.001), while the rates of intraoperative surgical complications (1.1% vs. 1.9%, p = 1.000) and the rate re-FP in the long term (8.4% vs. 15.1%, p = 0.19) during a follow-up period of 53.4 ± 44.5 months were comparable to the group without PAS. Conclusion In cases of PAS in children and young adults, FP for refractory GERD might necessitate longer operative times and longer hospital stays but can be performed with surgery-related short- and long-term complication rates comparable to cases without PAS.

Gastro-oesophageal reflux disease in children with neurological impairment: a retrospective cohort study

ObjectivesTo determine the incidence and prevalence of gastro-oesophageal reflux disease (GERD) diagnosis and treatment in children with neurological impairment (NI) along with relationship to key variables.DesignThis is a population-based retrospective...