Untreated Gastroesophageal Reflux Disease Research Articles

The Impact of Gastroesophageal Reflux Disease and Proton Pump Inhibitor Use on the Risk of Repeat Catheter Ablation for Atrial Fibrillation.

Gastroesophageal reflux disease (GERD) has been associated with increased incidence/recurrence of atrial fibrillation (AF). However, the impact of GERD and proton pump inhibitor (PPI) therapy on outcomes of AF catheter ablation remains unclear. We aimed to assess the association between the presence of GERD and risk of repeat AF ablation, stratified by PPI therapy. A retrospective cohort study was conducted on patients with paroxysmal/persistent AF undergoing initial ablation in January 2011-September 2015. GERD was defined by endoscopic findings, objective reflux testing, or clinical symptoms. The association between GERD/PPI use and time to repeat ablation was evaluated by time-to-event analysis with censoring at the last clinic follow-up within 1 year. Three hundred eighty-one subjects were included. Patients with GERD (n = 80) had a higher 1-year repeat ablation rate compared with those with no GERD (25% vs 11.3%, P = 0.0034). Stratifying by PPI use, patients with untreated GERD (37.5%) more likely needed repeat ablation compared with reflux-free (11.3%, P = 0.0003) and treated GERD (16.7%, P = 0.035) subjects. On multivariable Cox regression analyses, GERD was an independent risk factor of repeat ablation (hazard ratio [HR] 3.30, confidence interval [CI] 1.79-6.08, P = 0.0001). Specifically, untreated GERD was associated with earlier repeat ablation compared with no GERD (HR 4.02, CI 1.62-12.05, P = 0.0013). However, no significant difference in repeat ablation risk was noted between reflux-free and PPI-treated GERD groups. GERD was an independent predictor for risk of repeat AF ablation within 1 year, even after controlling for major cardiovascular comorbidities and confounders. PPI therapy modulated this risk, as repeat ablation-free survival for PPI-treated GERD was noninferior to reflux-free patients.

Effect of cardio-gastric interaction on atrial fibrillation in GERD patients

Objective: Atrial fibrillation (AF) and gastroesophageal reflux disease (GERD) are very common in daily clinical practice. Post-prandial AF episodes have been reported in GERD patients. Although it was reported in previous studies that it was caused by sympathovagal imbalance, there are no studies on cardiac conduction system involvement. In this study, we aimed to evaluate whether the risk of developing AF increases in untreated GERD patients with non-invasive electrophysiological tests.
 Methods: The research was prospectively performed. Endoscopy was performed on the individuals due to reflux complaints. ECG was recorded at 25mm/s and 10 mm/mV amplitude, and 24-hour Holter ECG (three-channel; V1, V2, and V5) was performed. ECG parameters were measured and Holter ECG results were analyzed.
 Results: A total of 120 individuals, 60 patients and 60 controls, were included. No significant statistically differences existed between groups for hypertension, diabetes, smoking, or dyslipidemia (p>0.05). In terms of heart rate, Pmax, Pmin, QTd, and QTcd, there were no significant differences across the two groups (p>0.05). P-wave dispersion (Pd) was substantially higher in the study group (p=0.014). Comparing the heart rate variabilities of 24-hour Holter ECG recordings across the groups, the standard deviation of R-R intervals (SDNN) was substantially higher in the study group (p

FLOT or CROSS for gastroesophageal junction cancersâ€"is the debate over yet?

In the last two decades, the incidence of gastroesophageal junction (GEJ) adenocarcinomas (AC) has increased, in part due to the increasing prevalence of obesity and untreated gastroesophageal reflux disease (GERD). Esophageal and GEJ cancers have become one of the leading causes of cancer deaths worldwide due to its aggressive nature. While the mainstay of treatment for locally advanced gastroesophageal cancers (GECs) remains surgery, several studies have now shown that multimodality approach yields better outcomes. GEJ cancers have historically been included both in esophageal cancer as well as gastric cancer trials. Therefore, both approaches, neoadjuvant chemoradiation (CRT) or perioperative chemotherapy are considered standard treatment options. thereon the same token, there yet remains a debate for the 'gold standard' treatment of locally advanced GEJ cancers. The landmark trials, fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT) and ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS), have shown similar improvements in overall survival (OS) and disease-free survival (DFS) for patients with resectable locoregional GEJ cancers. In this review, the authors attempt to highlight the historical evolution of current standard treatments and provide a sneak peek into the future of treatment of GEJ cancers. Several factors must be borne in mind when making the optimal choice for a patient. Some of these include surgical candidacy, tolerance to chemotherapy, eligibility for radiation (RT) as well as institutional preferences.

Updates on Surgical Treatment for Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a common condition that is on the rise. Obesity is one risk factor that has increased in parallel with the rise of GERD. Typical symptoms include heartburn, regurgitation, dysphagia, cough, and chest pain. Patients with typical symptoms are empirically treated with proton pump inhibitors (PPIs). If the diagnosis is not clear, further evaluation is performed with endoscopy, pH monitoring, and esophageal manometry. Untreated GERD increases the risk of esophagitis, esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma. Treatment begins with lifestyle modification and medical therapy. If these fail, surgical and endoscopic surgical techniques are available, to provide treatment, symptom relief, and reduce long-term PPI use.

Laparoscopic sleeve gastrectomy with Rossetti fundoplication: long-term (5-year) follow-up.

Gastroesophageal reflux disease (GERD), including erosive esophagitis, is highly prevalent in the obese population. Barrett's esophagus is the consequence of untreated GERD. Laparoscopic sleeve gastrectomy is one of the most frequently performed bariatric procedures. This study presents results after 5 years of follow-up of combined LSG and Rossetti fundoplication for the treatment of GERD, esophagitis, and Barrett's esophagus in patients with morbid obesity. To evaluate long-term results after sleeve gastrectomy with Rossetti fundoplication. Public university hospital in Italy. Since January 2015, more than 450 patients with obesity underwent sleeve gastrectomy with a Rossetti fundoplication procedure as part of prospective studies underway at our center performed by 4 different expert bariatric surgeons. Currently, 127 patients have a follow-up of 5 years or more. Mean patient age was 42.9 ± 10.3 years, and mean body mass index was 42.4 ± 6.1 kg/m². In total, 74.8% of patients were experiencing GERD before surgery. In 29 of 127 patients (22.8%), preoperative gastroscopy showed signs of esophagitis and/or Barrett's esophagus. In particular, 23 of 127 patients (18.1%) had grade A esophagitis, 2 of 127 (1.6%) had grade B, 2 of 127 (1.6%) had grade C, and 2 of 127 (1.6%) had Barrett's esophagus. Mean operative time was 51 ± 21 minutes. No intraoperative complications or conversions were reported. A regular postoperative course was seen in 91.3% of patients. Sixty months after surgery, more than 95% of patients did not experience any reflux symptoms. Percent total weight loss at follow-up was comparable with that with sleeve gastrectomy. Endoscopic follow-up demonstrated improvement of esophagitis lesions (including Barrett's esophagus) present in the preoperative setting. Laparoscopic sleeve gastrectomy with Rossetti fundoplication is well tolerated, feasible, and safe in patients with obesity, providing adequate weight loss results and complete resolution of clinical signs of GERD. We have recorded an improvement in esophagitis lesions present at preoperative gastroscopy and complete resolution of Barrett's esophagus within 5 years of follow-up.

Prevalence of Gastroesophageal Reflux Disease and Associated Risk Factors in the Eastern Region, Saudi Arabia.

BackgroundGastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by heartburn and acid regurgitation. A higher incidence is found in Arab countries. Untreated GERD has a negative impact on individuals that interfere with daily activities and impaired quality of life. This study aims to estimate the prevalence of GERD and associated risk factors in the Eastern region, Saudi Arabia.Material & MethodologyA descriptive cross-sectional study was carried out among 1517 healthy participants from the Eastern province of Saudi Arabia from May to August 2021. The sample was randomly collected through a structured self-administered questionnaire. The questionnaire was composed of questions related to sociodemographic and lifestyle characteristics as risk factors for GERD. The existence of GERD was assessed by using GERD Questionnaire (GerdQ) for diagnosing GERD, when the score is 8 or more.ResultsA total of 1517 participants were included in the study: 58.8% male, 41.2% female; 9% of whom were pregnant. The age of participants ranged from 18 to 58 with a mean age of 27.5 ± 11.4 years old. The existence of GERD was 20.6% among the total participants, in which their GerdQ scores were 3-7 (68.9%), 8-10 (22.1%), and 8-11 (8.5%). The higher risk groups of having GERD were pregnant women, smoker, being male, regular usage of analgesia, soft drinks, and having a family history of GERD.ConclusionThis study showed the prevalence of GERD among the general population of the Eastern region, Saudi Arabia was 20.6%. Several sociodemographic and lifestyle characteristics were associated with the disease. Further studies are needed to explore the role of psychological factors in developing GERD.

Association of Treated and Untreated Gastroesophageal Reflux Disease in the First Year of Life with the Subsequent Development of Asthma.

Introduction: Gastroesophageal reflux disease (GERD) as well as its treatment with acid-suppressive medications have been considered possible risk factors for the development of asthma, but few studies have disentangled the role of GERD with that of its treatment. The present study aimed at estimating the association of treated and untreated GERD in the first year of life with the risk of asthma. Methods: Retrospective cohort study including all children born between 2004 and 2015 registered in Pedianet, an Italian primary care database. We analyzed the association of children exposed to GERD (both treated and untreated) in the first year of life with the risk of developing clinically assessed asthma (clinical asthma) after 3 years. Secondary outcomes included asthma identified by anti-asthmatic medications (treated asthma) and wheezing after 3 years. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated comparing children with and without GERD, stratifying by treatment with acid-suppressive medications. Results: Out of 86,381 children, 1652 (1.9%) were affected by GERD in the first year of life, of which 871 (53%) were treated with acid-suppressive medications. Compared with controls, children with GERD were at increased risk of clinical asthma (HR: 1.40, 95% CI 1.15–1.70). Risks were similar between treated and untreated GERD (p = 0.41). Comparable results were found for treated asthma, but no risk increase was seen for wheezing. Discussion: Early-life GERD was associated with subsequent childhood asthma. Similar risks among children with treated and untreated GERD suggest that acid-suppressive medications are unlikely to play a major role in the development asthma.

Salivary microbiome with gastroesophageal reflux disease and treatment

The effect of oral microbial composition on periodontal health and on systemic health has been, and is being established. The oral microbiome, in turn, can be altered by local and systemic diseases and conditions. Gastroesophageal reflux disease (GERD), has been associated with increased acidity in the oral cavity resulting in dental erosion, and controversially a reduced risk of periodontal disease. We hypothesized that presence of GERD was linked to a modified microbial profile in untreated GERD patients and that the use of proton pump inhibitor (PPI) drugs: potent disruptors of gut microbiome, in GERD patients might result in a salivary microbiome that is further distinct. Untreated GERD patients showed multiple differences in salivary microbiome as compared to healthy controls. Taxa found at lower levels related to the presence of GERD not treated by PPI included: Prevotella melaninogenica, Prevotella pallens, Leptotrichia, and Solobacterium moorei and thirteen others. In contrast, GERD patients chronically using PPI showed minimal differences in salivary taxa compared to healthy controls not using PPI.

Regression of Barrett's esophagus after magnetic sphincter augmentation: intermediate-term results.

Untreated gastroesophageal reflux disease (GERD) can lead to Barrett's esophagus and an increased risk for esophageal adenocarcinoma. Magnetic sphincter augmentation (MSA) isa safe and effectivemodality forthe treatment of GERD. Preliminary research on short-term outcomes after MSA demonstrated significant regression of Barrett's. Further investigation is required to evaluate the long-term effect of this treatment. A retrospective review of patients was conducted with biopsy-proven Barrett's esophagus who underwentMSAbetween 2007 and 2019. As a part oftheirpreoperative evaluation,patients underwent esophagogastroduodenoscopy (EGD) with biopsies of the distal esophagus and gastroesophageal junction including any abnormal-appearing segments, pH testing, andavideoesophagram. Patients were categorized according to the length of Barrett's identified (ultrashort < 1cm, short 1-3cm, long > 3cm). Improvement was defined asa decrease in length (e.g. long to short). There were 87 patients identified for study inclusion. 55 patients were male. Themedianbody mass indexwas 26.95. The median age was 61.81 (49.79-68.29). Mean follow-up time was 2.35 ± (1.57) years. 7 (8.0%)of these patients beganwith long segment Barrett's, 58 (66.7%) began with short segment disease, and 22 (25.3%) began with an ultrashort segment. Within this cohort, 74 (85.06%) had undergone postoperative biopsy. 7 out of 74 patients(9.46%)showed improvement in their intestinal metaplasia and 45/74(60.81%)showed complete regression. Fisher's exact test showed a significant decrease in Barrett's length following MSA (p = 0.002). No patients progressed to dysplasia or neoplasia. There was a statistically significant decrease in the median Demeester score from 34.00 to 13.70 after surgery (p < .001). MSA reducesesophageal acid exposure and can lead to reduction or resolution of Barrett's esophagus. MSAis also effective atpreventingprogression ofmetaplasiatodysplasia or neoplasia. This effectremains consistenteven after 2 years of follow-up.

Surveillance in Patients With Esophageal Atresia/Tracheoesophageal Fistula.

Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a congenital aerodigestive anomaly with high survival rates after surgical repair. Care should now be focused on prevention of long-term complications using appropriate surveillance techniques. The incidence of gastroesophageal reflux disease (GERD) is high in patients with EA/TEF. Consequences of untreated GERD include esophagitis, strictures, and Barrett esophagus. Subjective symptoms are an unreliable indicator of presence or severity of GERD, and therefore, diagnostic testing is needed to assess esophageal heath and monitor the effectiveness of anti-reflux treatment. Esophagogastroduodenoscopy with biopsy remains the primary surveillance tool, but is invasive and not without risks. Less-invasive modalities such as multichannel intraluminal impedance and pH monitoring to assess GERD appear to correlate strongly with esophageal histology and may provide sufficient information to guide treatment. EA/TEF patients face numerous challenges that need to be considered. Routine surveillance protocols and close monitoring are warranted to assess complications. Further research is needed to delineate the frequency of esophagogastroduodenoscopy versus less-invasive and promising modalities such as multichannel intraluminal impedance-pH monitoring.

Esophageal adenocarcinoma and Barrett esophagus in a neurologically impaired teenager

Esophageal adenocarcinoma (EAC) accompanied by Barrett esophagus (BE) is rare in patients younger than 20years old. EAC in the upper esophagus is also rare. We report a rare case of EAC with BE that developed in the upper esophagus after chronic, untreated gastroesophageal reflux disease in a neurologically impaired teenager. A 19-year-old neurologically impaired man underwent endoscopy for evaluation of dysphagia and vomiting, and was diagnosed with EAC with BE. He underwent transthoracic esophagectomy, extensive lymph node dissection, and cervical esophagogastric anastomosis, but the prognosis was poor. Pathology indicated poorly differentiated adenocarcinoma with BE.

PTU-143 Clinical Yield of Using Common Reflux-Symptom Correlation Methods: A Retrospective Study Comparing The Demeester Score, Symptom Index, and Symptoms Association Probability in Predicting Response to Antireflux Treatment in Patients with GORD

Introduction Oesophageal pH-impedance monitoring is the gold standard for the diagnosis of gastroesophageal reflux disease (GORD). The DeMeester score is a global measure of acid exposure calculated from reflux parameters. Symptom Index (SI) and the Symptoms Association Probability (SAP) scores correlate symptoms to episodes of gastroesophageal reflux (GOR). Currently, it is not clear which of these scoring methods best relate to the patient’s response to treatment. This study investigates the value of these 3 metrics in predicting the clinical outcome of treatment in GORD patients. Methods We retrospectively selected patients who had 24 hour pH-impedance monitoring on suspicion of GORD during December 2014 to October 2015. Abnormal DeMeester was defined as ≥14.72, +ve SI as ≥50%, and +ve SAP as ≥95%. The Reflux Disease Questionnaire (RDQ) was completed by each patient before investigation. After reflux monitoring, patients were followed up to calculate their post-treatment RDQ at least 2 months post treatment. Sensitivity, specificity, positive and negative likelihood ratios and predictive values were calculated. Results 42 patients (11 male; total mean age 51 [25–79]) were included. 25 (59.52%) of these patients were treated. Of these, 21 patients, had medical treatment and 6 had surgical treatment (2 had both). 10/25 (40%) had a reduced RDQ score post-treatment: 8/10 (80%) having medical treatment, 1/6 (23.33%) having surgical treatment. In patients without treatment, 7/17 (41.18%) had a reduced RDQ. The two-tailed p value between the treated and untreated group was not significant (p = 1.00). Considering individual metrics, abnormal DeMeester score showed highest specificity and SAP showed the highest sensitivity in predicting lowering RDQ score post-treatment. When combining different metrics, having all three parameters positive yielded the highest overall clinical value: sensitivity 60%, specificity 95%, positive likelihood ratio 12, positive predictive value 75%, negative predictive value 90% (table 1). Conclusion In patients diagnosed with GORD by pH-impedance monitoring, having all three parameters positive i.e. abnormal DeMeester score, SAP +ve and SI +ve had a high overall value in predicting the response to treatment. Nevertheless, reduction of RDQ was equally seen in untreated GORD group. A study on a larger number of patients might be required to further confirm the findings of this research Disclosure of Interest None Declared

Lung diffusion capacity in children with respiratory symptoms and untreated GERD

BackgroundGastroesophageal reflux disease (GERD) is associated with many respiratory disorders, among which, chronic cough, laryngitis, and asthma are among the most common. We investigated lung function, including gas diffusion capacity, in children with poor asthma control or chronic laryngitis with untreated GERD.Material/MethodsA total of 71 children, aged 6–17 years, with chronic respiratory and other symptoms suggestive for GERD, were enrolled and divided into 2 groups: chronic laryngitis and asthma. Participants underwent 24-hour pH monitoring and lung function assessment, measurement of single-breath diffusing capacity of the lung for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FENO) measurement.Results24-hour pH monitoring was positive for GERD in 92.1% of preselected children with asthma and 90.1% of children with chronic recurrent laryngitis. All flows (PEF, MEF75, MEF50, and MEF25) were significantly lower in the asthma group, while FENO and DLCO were significantly lower in the laryngitis group. A significant inverse relationship was found between DLCO and all reflux indexes in the laryngitis group. Each unit change of Johnson-DeMeester score and Boix-Ochoa score increased the odds for significantly lower DLCO in laryngitis patients by 3.9% and 5.5%, respectively.ConclusionsIn children with uncontrolled asthma and chronic laryngitis, the regurgitation of gastric contents due to GERD contributes to poor asthma control and aggravation of chronic laryngitis. Despite having normal lung function, the gas diffusion capacity should be controlled in patients with GERD and chronic laryngitis, and it might be the very first abnormality in distal airways.

Gastroesophageal Reflux

Gastroesophageal Reflux

Educating the Patient With Gastroesophageal Reflux Disease (GERD): More Must Be Done at the Primary Care Level

Purpose: To assess the patient's general knowledge regarding gastroesophageal reflux disease (GERD) and the modifiable risk factors associated with the condition in patients suffering from GERD in the primary care setting. Methods: After informed consent was obtained, a multiple choice question survey was admistered in person to 333 patients carrying a diagnosis of GERD in the primary care setting. Results: 333 out of 333 patients that gave informed consent completed the survey. 49.5% (165) of patients were male. Mean age was 43.7±13.1 years. 33.9% (113) of patients stated that they did not have an in-depth discussion with their primary care physician regarding lifestyle modifications and risk factors affecting GERD. 74.7% (249) of patients were taking a PPI. Of those taking a PPI, 39.4% (98) of patients did not know the correct time to take their PPI. Only 32.7% (109) of patients were aware that elevating the head of the bed or placing pillows under their head and neck to elevate their torso while sleeping was associated with less GERD symptoms. Patients that had an in-depth discussion with their PCP were significantly more likely to know the best position to sleep in order to avoid the symptoms of GERD than those patients who did not have an in-depth discussion with their PCP (p=0.049). Patients that had an in-depth discussion with their PCP were significantly more likely to know that eating small meals 6 times daily was better than eating fried foods and eating 3 normal sized meals daily in reducing the symptoms of GERD than patients who did not have a discussion with their PCP (p<0.001). Patients that had an in-depth discussion with their primary care doctor were more likely to know that weight reduction through moderate exercise and smoking cessation was associated with reduced GERD symptoms than those patients who did not have a discussion (p<0.001). 82.3% (274) of patients were not aware that coffee, alcohol, milk and citrus drinks can all be associated with worsening GERD symptoms. 31.8% (106) of patients were unaware that untreated GERD can result in a condition associated with cancer of the esophagus. Conclusion: In our study, one-third of patients did not have an indepth discussion with their primary care physician regarding GERD and its modifiable risk factors. Patients that had an indepth discussion were likely to better educated regarding their condition that those who did not. Because GERD affects at-least 20% of the entire western population and is associated with increased healthcare costs and reduced quality of life, more emphasis should be placed in the education of the patient suffering from the disease at the primary care level.

Unrecognized GERD Symptoms Are Associated with Excessive Daytime Sleepiness in Patients Undergoing Sleep Studies

Sleep disturbances are commonly reported by patients who suffer from gastroesophageal reflux disease (GERD) but it is uncertain if GERD plays a role in patients with sleep disorders of undetermined origin. The prevalence of GERD in patients with sleep disorders of unknown etiology is uncertain; the aim of this study was to determine this prevalence. Three hundred eighty-five consecutive patients reporting to an outpatient clinic for evaluation of sleep disorders were assessed for their sleepiness in relation to reflux symptom intensity. Reflux symptoms that met the survey criteria for a diagnosis of GERD were present in 45 of the 385 subjects (12.8%). These subjects did not have a diagnosis of GERD and were not being treated. Multiple regression analysis showed that excessive sleepiness was associated with intensity of GERD symptoms. Patients with GERD had significantly higher Epworth sleep scores than patients without GERD (12.8 vs. 10.6; p=0.007), indicating more daytime sleepiness. We conclude that unrecognized and untreated GERD are present in many patients presenting with sleep disorders. Patients with GERD had significantly greater sleepiness. Further studies of the impact of GERD treatment in this population are necessary.

The prevalence of sexual behavior disorders in patients with treated and untreated gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a chronic disease. Sexual behavior is often altered in chronic illness. The aim of this study was to evaluate sexual behavior in patients affected with GERD before and after medical or surgical treatment in comparison to healthy controls (HC). Upper GI endoscopy and 24-h ambulatory pH testing were performed to confirm GERD in symptomatic patients. GERD patients completed an anonymous questionnaire on sexual life before and after medical or surgical treatment. Compared with HC, untreated patients with GERD showed more frequent difficulty in attaining orgasm and painful intercourse. GERD patients after surgical treatment had significantly more difficulty in attaining orgasm, while after continuous medical treatment GERD patients compared with HC had significantly more difficulty in attaining orgasm, higher painful intercourse, lower sexual desire, and perceived more frequently that the partner was unhelpful. When compared with untreated conditions, GERD patients after surgical treatment had a significant improvement in attaining orgasm and in painful intercourse but a significant decrease in sexual desire, a lower satisfaction with their sexual life, and a higher prevalence of an unhelpful partner, whereas GERD patients after medical treatment had a decrease in all indices of sexual behavior. Untreated GERD is associated with disorders in sexual behavior. Compared with HC, only the surgical group partially improved after treatment.

Gastroesophageal reflux disease: Natural history and long-term medical and surgical outcomes

Gastroesophageal reflux disease (GERD) is a chronic condition that affects a large proportion of the adult population. Persistent untreated GERD can lead to esophageal strictures, premalignant Barrett's esophagus, and an increased risk of adenocarcinoma of the esophagus. Currently, the most effective medical treatment targets gastric acid suppression, allowing healing of erosive/peptic lesions and controlling symptoms. Most patients take over-the-counter medication or are successfully treated by their primary care physician. Gastroenterologists and gastrointestinal surgeons see patients with complications, refractory symptoms despite acid-suppressive therapy, or atypical symptoms. For the medical management of GERD, proton pump inhibitors are potent acid suppressants with favorable side-effect profiles and long-term efficacy and safety. Medical therapy can heal 80% to 100% of patients with erosive esophagitis with 30% to 60% of patients reporting sustained resolution of heartburn. Surgery may be offered to patients with GERD as an alternative to long-term antireflux medication. Careful selection of appropriate surgical candidates is important, and the risk of developing new or recurrent symptoms requiring medication should be disclosed to patients contemplating the surgical alternative.

Complications of Pediatric Laryngotracheal Reconstruction: Prevention Strategies

A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent these infections. We also advocate the treatment of GERD during the healing phase of LTR.