Pediatric Gastroesophageal Reflux Surgery Treatment & Management

  • Author: Tom Jaksic, MD, PhD; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: Apr 19, 2010
 

Medical Therapy

The North American Society of Pediatric Gastroenterology and Nutrition has issued clinical guidelines for the management of gastroesophageal reflux disease (GERD).[57] For additional information, see the eMedicine pediatric topic Esophagitis.

First-line treatment for GER is generally medical, with surgery reserved for complications of GERD or failed medical therapy.

Positioning change is a simple intervention that may help. A study evaluating the effects of infant positioning on combined impedance and pH probe monitoring found that placing the infant in the left-side-down or prone position postprandially decreased esophageal exposure to GER.[58] Another study evaluating left lateral versus right lateral positioning found that right lateral positioning facilitated gastric emptying but was associated with more GER than the left lateral position.[59] Teaching parents proper positioning, as well as optimal feeding technique with frequent low-volume feedings and thickened food may improve symptoms.

A study of conservative therapy taught in a primary care setting found a significant improvement in symptoms, with 24% of infants normalizing their Infant Gastroesophageal Reflux Questionnaire-Revised score after 2 weeks.[60] Thickened formula to treat GER has been studied extensively. A recent meta-analysis of 14 randomized controlled trials found that the use of thickened formula decreased the percentage of infants with regurgitation and the number of vomiting and regurgitation episodes, shortened the duration of the longest reflux episode, and improved weight gain when compared with controls. Factors that were unaffected by thickened feedings included the number of reflux episodes or reflux index (percentage of examination time with pH < 4.0).[61]

In infants with confirmed GERD, management with medications is appropriate. Acid suppressants are useful in treating esophagitis induced by acid reflux and should be used either alone or concomitantly with prokinetic agents.[62] Histamine-2 receptor antagonists (H2RAs; eg, ranitidine, cimetidine, famotidine, nizatidine) and proton pump inhibitors (PPIs; eg, omeprazole, esomeprazole, lansoprazole) have been shown to be effective in the treatment of GER. Numerous studies have demonstrated the effectiveness of H2RAs in adults with reflux, and 3 randomized controlled trials with children showed H2RAs to be effective in both relieving symptoms and healing esophagitis.[63, 64]

Numerous randomized controlled trials have indicated that PPI therapy is superior to H2RAs in adults with GERD.[65] PPIs are also used to treat GER in children. Although no randomized placebo-controlled studies have been conducted in children, multiple studies have shown that they are generally well tolerated,[66, 67, 68, 69] even in infants and neonates. The improvement in symptoms may be dose related,[70] with higher doses associated with a faster response.[71] However, studies of lansoprazole have also shown that infants younger than 10 weeks have different pharmacokinetics and require a lower dose[72] and that adverse effects may be more common in those younger than 28 days.[73] Several studies report that PPIs are an effective treatment of reflux esophagitis, but none has demonstrated superiority over high-dose H2RAs.[74, 75, 76, 77, 78]

Prokinetic agents improve esophageal peristalsis, increase gastric emptying, and increase LES tone. Cisapride is effective in decreasing reflux; however, it was removed from the market due to potentially lethal cardiotoxicity and is available only in a limited-use protocol.[79, 80, 81] Metoclopramide is an antidopaminergic and cholinomimetic drug that has been used in medical management of GERD. However, the FDA recently issued a black box warning for this drug owing to its association with tardive dyskinesia, an irreversible neurologic effect.[82] Some studies have shown that the adverse effects of metoclopramide are independent of dose and duration of use.[83, 84, 85]

Erythromycin is a macrolide antibiotic that stimulates motility by direct effect on the motilin receptors of the intestines.[86] A double-blind, randomized, controlled trial of erythromycin versus placebo evaluated time to attain full enteral feeding in very low birth weight preterm infants with feeding intolerance. Although reflux symptoms improved over time in both groups, there was no statistically significant difference between groups in resolution of reflux symptoms or time to reach full enteral nutrition.[87] Two other drugs that increase peristalsis of the esophagus and stomach include bethanechol (Urecholine) and domperidone.

Antireflux surgery should be considered when medical therapy fails (ie, when patients have continued symptoms, refractory esophagitis, or complications of GERD). Children with neurologic impairment are more refractory to medical therapy than otherwise healthy children.[88]

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Surgical Therapy

Surgery is usually reserved for patients with continued reflux and complications of reflux esophagitis despite medical therapy. In the pediatric population, more than 50% of antireflux operations are performed in children younger than 1 year.[89] Antireflux surgery improves symptoms (esophagitis, pulmonary infections, failure to thrive) in over 95% of children, with an associated morbidity rate of less than 7% and a mortality rate of less than 1%.[90, 12]

The principles of surgical therapy for GERD include lengthening of the intra-abdominal esophagus, accentuation of the angle of His, increasing the pressure barrier at the esophagogastric junction, and approximation of the crura.[91] The Nissen fundoplication is the most common operation performed today (see the first image below). It involves wrapping the gastric fundus 360° around the distal esophagus. Alternatives to the Nissen fundoplication include the Thal procedure (anterior 180° fundoplication), Toupet procedure (posterior 270° fundoplication; see the second image below), Boix-Ochoa procedure (restoration of intra-abdominal esophagus and recreation of the angle of His), and Watson fundoplication (anterior 120° fundoplication). Comparisons between these various operations have demonstrated an equivalent rate of complications, revisions, and long-term satisfaction.[92, 93]

Nissen fundoplication. Nissen fundoplication. Toupet partial fundoplication. Toupet partial fundoplication.

The Nissen procedure and other related procedures may be performed laparoscopically. Laparoscopic fundoplication has been well studied and accepted as equivalent to open procedures in adults.[8, 94, 9] Findings from early follow-up studies suggest that laparoscopic fundoplication in children is also comparable with open surgery and is associated with a shorter hospital stay.[95, 96, 10, 11, 12] The safety of laparoscopic as compared with open fundoplications has been evaluated in children as young as one year.[97] Some have found the reoperation rate to be higher after the laparoscopic procedure.[98] Laparoscopic antireflux operations have also been reported to be safe and effective in children after the repair of esophageal atresia.[99]

Delayed gastric emptying may occur in patients with symptomatic GERD and appears to be more common in children with neurologic impairment.[100] In addition, delayed gastric emptying prior to surgery is thought to be a risk factor for recurrent reflux.[101] Although a gastric-emptying operation may be performed in conjunction with fundoplication, its routine use is controversial.[102, 103] One study has shown accelerated gastric emptying in children following laparoscopic Nissen fundoplication, suggesting that procedures to improve gastric emptying, such as pyloroplasty, may not be indicated.[104] Dumping syndrome is a potential complication of all gastric-emptying procedures.

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Preoperative Details

Whether laparoscopic or open, numerous procedures are available to treat GERD, including complete and partial fundoplication. Although the Nissen 360º fundoplication is the most commonly performed antireflux procedure, a partial wrap may be preferable in some children with esophageal dysmotility, as it is less likely to cause esophageal obstruction in the context of abnormal esophageal peristalsis.[105]

Some technical details remain controversial. For example, most surgeons approximate the crura of the diaphragm. Many also divide the short gastric vessels, believing that this allows a looser wrap and leads to less postoperative dysphagia. However, some suggest that these are unnecessary and time-consuming steps.[106]

Two other procedures that are sometimes performed concomitantly with antireflux surgery in children include a gastric emptying procedure and placement of a gastrostomy tube (G-tube). Delayed gastric emptying is reported in approximately 50% of children with GER,[107] and some have recommended that all children undergo contrast scintigraphy preoperatively. Those with slow gastric emptying (ie, >60% of isotope retained in the stomach after 90 min) should then undergo a gastric emptying procedure, such as pyloroplasty.[101, 100, 108] This recommendation is controversial because other studies have shown that fundoplication alone accelerates gastric emptying.

Finally, some children who have antireflux surgery also benefit from a G-tube. A G-tube should be considered in children with neurologic impairment,[109] poor gastric motility, or poor nutritional status. In addition to facilitating postoperative feeding, it allows drainage or venting of the stomach, as needed.

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Intraoperative Details

As mentioned above, whether laparoscopic or open, numerous procedures are available, including complete and partial fundoplication. Although the Nissen 360º fundoplication is most commonly used, a partial wrap is sometimes preferred in children with esophageal dysmotility disorders who are undergoing surgery because this is less likely to cause esophageal obstruction in the context of abnormal esophageal peristalsis.[105]

In addition, each type of fundoplication may be tailored to the patient and to the surgeon's preference. For example, most surgeons approximate the crura of the diaphragm. Many also divide the short gastric vessels, believing that this allows a looser wrap and leads to less postoperative dysphagia. However, some suggest that this is an unnecessary and time-consuming step.[106]

Two other procedures that are often performed concomitantly with antireflux surgery in children include a gastric emptying procedure and placement of a gastrostomy tube (G-tube). Delayed gastric emptying is reported in approximately 50% of children with GER.[107] Some have recommended that all children have contrast scintigraphy preoperatively. Those with slow gastric emptying (ie, >60% of isotope retained in the stomach after 90 min) should then have a gastric emptying procedure, such as antroplasty or pyloroplasty.[101, 100, 108] However, this point is controversial.

Finally, some children who have antireflux surgery also benefit from a G-tube. Many surgeons place G-tubes in children with neurologic impairment at the time of fundoplication.[109] In addition, a G-tube may be indicated in children with failure to thrive or malnutrition preoperatively. In addition to enabling postoperative feeding, it allows drainage or venting of the stomach postoperatively, as needed.

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Postoperative Details

Some surgeons leave a nasogastric tube in place or leave the G-tube to gravity until return of bowel function. This is not always done, particularly if a laparoscopic approach is used. The patient should be started on a clear liquid diet initially (either by mouth or feeding tube), then slowly transitioned to formula or soft solids. Although there is scant evidence in children, many surgeons believe that laparoscopic surgery hastens the postoperative return of bowel function and advances the diet more quickly than open surgery.

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Follow-up

Fundoplication usually provides immediate symptom relief; however, it can be associated with complications. Problems occur more frequently in children with neurologic impairment than in otherwise healthy children,[17] and vigilance is required (see Complications).

For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education article Spitting Up in Infants.

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Complications

Antireflux surgery itself is associated with complications, including retching, bloating, and unwrapping or slippage of the fundoplication. In addition, antireflux surgery may not eliminate the need for antireflux medications. A retrospective cohort study of 342 children undergoing laparoscopic Nissen fundoplication found that 76% had been restarted on antireflux medications within 1 year of surgery and that the use of antireflux medications postoperatively was unchanged in neurologically impaired patients.[110]

Postoperative complications may occur early or late. Early complications include retching, gas bloat (patients with this complication are often unable to vomit), dysphagia, atelectasis, pneumonia, wound infection or dehiscence, small-bowel obstruction due to adhesions, and delayed gastric emptying. Dysphagia may result from postoperative edema and spontaneously resolves.

Retching most often occurs in children with neurologic impairment and in those who are air swallowers preoperatively. Retching may indicate an underlying gastric dysrhythmia and loss of central inhibition of the gastric emetic reflex that is exacerbated by the operation.[111, 112] It may be managed with prokinetic agents, temporary nasogastric tube placement or G-tube decompression. A gastric emptying operation may also be required. Early small-bowel obstruction from adhesive disease may be managed with a brief trial of nasogastric tube decompression and watchful waiting, but failure to resolve should prompt surgical exploration.

Late complications include bowel obstruction and wrap failure, including wrap disruption, slipped wrap, herniation of the wrap into the chest, or excessively tight wrap. Patients in whom the wrap fails typically present with dysphagia, retching, or recurrent reflux symptoms. In patients with suspected wrap failure, an upper GI barium study may help to evaluate the integrity and anatomy of the repair, and endoscopy may be used to diagnose recurrent or persistent esophagitis. In a retrospective review, 66% of patients undergoing revision fundoplications had a hiatal hernia on upper-GI contrast studies.[113] Wrap failure may necessitate a revision fundoplication if recurrent gastroesophageal reflux (GER) cannot be controlled medically.

Neurologic status seems to be a major predictor of surgical success. Findings from one study of 234 children over a 5-year period found a much higher incidence of late post-operative complications in the neurologically impaired group compared with neurologically normal controls (26% vs 12%).[17] Esophagogastric disconnection has been suggested for use in select children with severe neurologic impairment,[114] however, its use is controversial. Although some advocate it as a primary procedure in children with severe neurologic impairment, most surgeons feel it is a procedure of last resort.[115, 116]

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Outcome and Prognosis

Long-term data in children are sparse; however, the success of antireflux surgery is generally thought to be good. A series of more than 1000 laparoscopic Nissen fundoplications over 10 years in infants and children revealed good outcomes, with a 4% wrap-failure rate.[12]

A few reports of objective postoperative testing have questioned the benefit of surgery.[117] One study found a beneficial effect of surgery on the rate of reflux-related hospitalizations in children aged 1-4 years, but this effect was not noted in older children. In fact, this study demonstrated that older children with developmental delay experienced an increased rate of reflux-related hospitalizations after surgery.[118]

The 24-hour pH study has been used to objectively evaluate outcomes following antireflux surgery. A prospective review of 53 pediatric patients treated with the laparoscopic Thal fundoplication found that 25% had pathologic reflux at follow-up, although 90% of patients reported they were symptom-free. This underscores the need for additional objective outcome studies.

Both surgical and medical management tend to have a high failure rate in children with neurologic impairment.[17] Many of these children have serious coexisting morbidity and relatively short life expectancy. A study of 46 infants examined 5 years after Nissen fundoplication found that 24% had died of other medical problems.[119] Of the survivors, 74% had no recurrent symptoms, 12% required repeat operation or fundoplication, and 45% had had at least one postoperative complication. Another report of 109 children who underwent either Nissen or Boix-Ochoa antireflux procedures, with up to 10-year follow-up, found recurrent reflux in 20% of patients (91% of these cases occurred in the Boix-Ochoa group).[120]

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Future and Controversies

The future of gastroesophageal reflux (GER) therapy includes several endoscopic therapies that are gaining favor in adult populations and that may replace surgery in some patients. These therapies include radiofrequency ablation (Stretta procedure), the injection of inert substances at the LES, and endoscopic gastroplication.

In the Stretta procedure, a catheter is used to deliver radiofrequency energy, creating thermal lesions deep to the mucosa at the GE junction. An open-label trial of 112 adult patients with 12-month follow-up showed an improvement in GERD scores and mental health, as well as a decrease in acid exposure and requirement for PPIs, with no serious complications.[121] Another study compared the Stretta procedure with laparoscopic fundoplication in 140 adults with favorable results.[122] This procedure has also been reported in small numbers of children with some short-term success.[123]

Other described procedures include endoscopic injection of inert substances into the mucosa or muscle of the GE junction and endoscopic plication, which involves the placement of mucosal or transmural sutures at the LES-GE junction. A report on this gastroplication with an EndoCinch device in 22 adults and 1-year follow-up showed that patients had improved reflux scores and health-related quality of life, as well as decreased acid exposure and PPI requirements.[124] Long-term data on these techniques are not available, and the safety and efficacy of these techniques in children are unknown.[125] However, one report describes successful gastroplication in 17 children, with a mean age of 12.4 years.[126]

Finally, robot-assisted laparoscopic fundoplication in children has been reported with good results.[127] Operative time is a purported benefit of the robot-assisted approach; however, a recent prospective study comparing operative times for robotically assisted Thal fundoplication with those of conventional laparoscopic techniques found that, although certain challenging steps of the procedure were more efficient, the lengthy setup required negated any overall benefit.[128]

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Contributor Information and Disclosures
Author

Tom Jaksic, MD, PhD  Professor, Department of Surgery, Harvard University Medical School; Surgical Director, Center for Advanced Intestinal Rehabilitation, Senior Associate in Surgery, Vice-Chairman of Pediatric Surgery, Children's Hospital Boston

Tom Jaksic, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Melissa A Hull, MD  Fellow, Department of Surgery, Children's Hospital of Boston

Melissa A Hull, MD is a member of the following medical societies: American Society for Parenteral and Enteral Nutrition, International Pediatric Transplant Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Shimae C Fitzgibbons, MD  Research Fellow, Department of Pediatric Surgery, Boston Children's Hospital

Disclosure: Nothing to disclose.

Brian Alan Jones, MD  Research Fellow, Department of Surgery, Children's Hospital Boston and Harvard Medical School

Brian Alan Jones, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Kenneth Azarow, MD  Program Director, Pediatric Surgery, Children's Hospital and University of Nebraska Medical Center; Professor, Department of Surgery, Uniformed Services University of the Health Sciences

Kenneth Azarow, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Kurt D Newman, MD  Vice Chairman, Department of Pediatric Surgery, Children's National Medical Center; Professor, Departments of Surgery and Pediatrics, George Washington University School of Medicine

Kurt D Newman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Michael G Caty, MD  Professor of Surgery and Pediatrics, State University of New York at Buffalo; Consulting Staff, Department of Pediatric Surgery, Children's Hospital of Buffalo

Michael G Caty, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physician Executives, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, and Association for Surgical Education

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD  Professor of Surgery, Feinberg School of Medicine, Northwestern University; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

References

  1. Fonkalsrud EW, Ashcraft KW, Coran AG, et al. Surgical treatment of gastroesophageal reflux in children: a combined hospital study of 7467 patients. Pediatrics. Mar 1998;101(3 Pt 1):419-22. [Medline]. [Full Text].

  2. Boerema I. Hiatus hernia: repair by right-sided, subhepatic, anterior gastropexy. Surgery. Jun 1969;65(6):884-93. [Medline].

  3. Allison PR. Hiatus hernia: (a 20-year retrospective survey). Ann Surg. Sep 1973;178(3):273-6. [Medline].

  4. Varshney S, Kelly JJ, Branagan G, et al. Angelchik prosthesis revisited. World J Surg. Jan 2002;26(1):129-33. [Medline].

  5. Nissen R, Rossetti M, Siewert R. 20 years in the management of reflux disease using fundoplication [in German]. Chirurg. Oct 1977;48(10):634-9. [Medline].

  6. Kazerooni NL, VanCamp J, Hirschl RB, et al. Fundoplication in 160 children under 2 years of age. J Pediatr Surg. May 1994;29(5):677-81. [Medline].

  7. Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. Sep 1991;1(3):138-43. [Medline].

  8. Nilsson G, Larsson S, Johnsson F. Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period. Br J Surg. Jul 2000;87(7):873-8. [Medline].

  9. Wenner J, Nilsson G, Oberg S, et al. Short-term outcome after laparoscopic and open 360 degrees fundoplication. A prospective randomized trial. Surg Endosc. Oct 2001;15(10):1124-8. [Medline].

  10. Somme S, Rodriguez JA, Kirsch DG, Liu DC. Laparoscopic versus open fundoplication in infants. Surg Endosc. Jan 2002;16(1):54-6. [Medline].

  11. Rangel SJ, Henry MC, Brindle M, Moss RL. Small evidence for small incisions: pediatric laparoscopy and the need for more rigorous evaluation of novel surgical therapies. J Pediatr Surg. Oct 2003;38(10):1429-33. [Medline].

  12. Rothenberg SS. The first decade's experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg. Jan 2005;40(1):142-6; discussion 147. [Medline].

  13. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. Jun 1997;151(6):569-72. [Medline].

  14. Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics. Dec 1998;102(6):E67. [Medline].

  15. Gold BD. Outcomes of pediatric gastroesophageal reflux disease: in the first year of life, in childhood, and in adults...oh, and should we really leave Helicobacter pylori alone?. J Pediatr Gastroenterol Nutr. Nov-Dec 2003;37 Suppl 1:S33-9. [Medline].

  16. Halpern LM, Jolley SG, Johnson DG. Gastroesophageal reflux: a significant association with central nervous system disease in children. J Pediatr Surg. Feb 1991;26(2):171-3. [Medline].

  17. Pearl RH, Robie DK, Ein SH, et al. Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal children. J Pediatr Surg. Nov 1990;25(11):1169-73. [Medline].

  18. Omari TI, Barnett C, Snel A, et al. Mechanisms of gastroesophageal reflux in healthy premature infants. J Pediatr. Nov 1998;133(5):650-4. [Medline].

  19. Mittal RK, Rochester DF, McCallum RW. Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man. Gut. Dec 1987;28(12):1564-8. [Medline].

  20. Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology. Aug 1997;113(2):399-408. [Medline].

  21. Chitkara DK, Fortunato C, Nurko S. Esophageal motor activity in children with gastro-esophageal reflux disease and esophagitis. J Pediatr Gastroenterol Nutr. Jan 2005;40(1):70-5. [Medline].

  22. O'Sullivan GC, DeMeester TR, Joelsson BE, et al. Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence. Am J Surg. Jan 1982;143(1):40-7. [Medline].

  23. Winans CS, Harris LD. Quantitation of lower esophageal sphincter competence. Gastroenterology. May 1967;52(5):773-8. [Medline].

  24. Konkin DE, O'hali WA, Webber EM, Blair GK. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. Dec 2003;38(12):1726-9. [Medline].

  25. Little DC, Rescorla FJ, Grosfeld JL, et al. Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. Jun 2003;38(6):852-6. [Medline].

  26. Banjar HH, Al-Nassar SI. Gastroesophageal reflux following repair of esophageal atresia and tracheoesophageal fistula. Saudi Med J. May 2005;26(5):781-5. [Medline].

  27. Koch A, Rohr S, Plaschkes J, Bettex M. Incidence of gastroesophageal reflux following repair of esophageal atresia. Prog Pediatr Surg. 1986;19:103-13. [Medline].

  28. Orenstein SR. Esophageal disorders in infants and children. Curr Opin Pediatr. Oct 1993;5(5):580-9. [Medline].

  29. Orenstein SR, Shalaby TM, Cohn JF. Reflux symptoms in 100 normal infants: diagnostic validity of the infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila). Dec 1996;35(12):607-14. [Medline].

  30. Gupta SK, Hassall E, Chiu YL, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci. May 2006;51(5):858-63. [Medline].

  31. Heine RG, Jordan B, Lubitz L, Meehan M, Catto-Smith AG. Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress. J Paediatr Child Health. Mar 2006;42(3):134-9. [Medline].

  32. Suskind DL, Thompson DM, Gulati M, et al. Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation?. Laryngoscope. Aug 2006;116(8):1397-403. [Medline].

  33. Euler AR, Byrne WJ, Ament ME, et al. Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. Pediatrics. Jan 1979;63(1):47-51. [Medline].

  34. Tieder JS, Cowan CA, Garrison MM, Christakis DA. Variation in inpatient resource utilization and management of apparent life-threatening events. J Pediatr. May 2008;152(5):629-35, 635.e1-2. [Medline].

  35. Amin RS. Gastroesophageal reflux and infant apnea. J Pediatr. Sep 2000;137(3):298-300. [Medline].

  36. Alex N, Thompson JM, Becroft DM, Mitchell EA. Pulmonary aspiration of gastric contents and the sudden infant death syndrome. J Paediatr Child Health. Aug 2005;41(8):428-31. [Medline].

  37. Faubion WA Jr, Zein NN. Gastroesophageal reflux in infants and children. Mayo Clin Proc. Feb 1998;73(2):166-73. [Medline].

  38. Yüksel H, Yilmaz O, Kirmaz C, Aydogdu S, Kasirga E. Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease. Respir Med. Mar 2006;100(3):393-8. [Medline].

  39. Khoshoo V, Le T, Haydel RM Jr, Landry L, Nelson C. Role of gastroesophageal reflux in older children with persistent asthma. Chest. Apr 2003;123(4):1008-13. [Medline].

  40. Weinberger M. Gastroesophageal reflux disease is not a significant cause of lung disease in children. Pediatr Pulmonol Suppl. 2004;26:197-200. [Medline].

  41. Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. Dec 2004;99(12):2452-8. [Medline].

  42. Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O'Conner JA. Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedence-pH monitoring. J Pediatrics. 2006;149:216-219. [Medline].

  43. Hassall E. Barrett's esophagus: congenital or acquired?. Am J Gastroenterol. Jun 1993;88(6):819-24. [Medline].

  44. Mattioli G, Bax K, Becmeur F, Esposito C, Heloury Y, Podevin G, et al. European multicenter survey on the laparoscopic treatment of gastroesophageal reflux in patients aged less than 12 months with supraesophageal symptoms. Surg Endosc. Oct 2005;19(10):1309-14. [Medline].

  45. Mittal RK, Rochester DF, McCallum RW. Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans. Am J Physiol. Jan 1989;256(1 Pt 1):G139-44. [Medline].

  46. Mittal RK, McCallum RW. Characteristics of transient lower esophageal sphincter relaxation in humans. Am J Physiol. May 1987;252(5 Pt 1):G636-41. [Medline].

  47. Al-Khawari HA, Sinan TS, Seymour H. Diagnosis of gastro-oesophageal reflux in children. Comparison between oesophageal pH and barium examinations. Pediatr Radiol. Nov 2002;32(11):765-70. [Medline].

  48. Boix-Ochoa J, Lafuenta JM, Gil-Vernet JM. Twenty-four hour esophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg. Feb 1980;15(1):74-8. [Medline].

  49. Sondheimer JM. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr. May 1980;96(5):804-7. [Medline].

  50. Semeniuk J, Kaczmarski M. 24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease: analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis. World J Gastroenterol. Oct 14 2007;13(38):5108-15. [Medline].

  51. Vandenplas Y, Salvatore S, Vieira MC, Hauser B. Will esophageal impedance replace pH monitoring?. Pediatrics. Jan 2007;119(1):118-22. [Medline].

  52. Mattioli G, Pini-Prato A, Gentilino V, Caponcelli E, Avanzini S, Parodi S. Esophageal impedance/pH monitoring in pediatric patients: preliminary experience with 50 cases. Dig Dis Sci. Dec 2006;51(12):2341-7. [Medline].

  53. Mattioli G, Gentilino V, Caponcelli E, et al. Effectiveness of esophageal manometry in predicting the outcome of children with primary GER after floppy Nissen-Rossetti wrap. Surg Endosc. Oct 2004;18(10):1504-8. [Medline].

  54. Lombardi G, de' Angelis G, Rutigliano V, Guariso G, Romano C, Falchetti D, et al. Reflux oesophagitis in children; the role of endoscopy. A multicentric Italian survey. Dig Liver Dis. Sep 2007;39(9):864-71. [Medline].

  55. Chang EY, Minjarez RC, Kim CY, Seltman AK, Gopal DV, Diggs B, et al. Endoscopic ultrasound for the evaluation of Nissen fundoplication integrity: a blinded comparison with conventional testing. Surg Endosc. Oct 2007;21(10):1719-25. [Medline].

  56. Winter HS, Madara JL, Stafford RJ, et al. Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology. Oct 1982;83(4):818-23. [Medline].

  57. [Guideline] Henry SM. Discerning differences: gastroesophageal reflux and gastroesophageal reflux disease in infants. Adv Neonatal Care. Aug 2004;4(4):235-47. [Medline].

  58. Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Faldella G. The effect of body positioning on gastroesophageal reflux in premature infants: evaluation by combined impedance and pH monitoring. J Pediatr. Dec 2007;151(6):591-6, 596.e1. [Medline].

  59. van Wijk MP, Benninga MA, Dent J, Lontis R, Goodchild L, McCall LM. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. Dec 2007;151(6):585-90, 590.e1-2. [Medline].

  60. Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. Mar 2008;152(3):310-4. [Medline].

  61. [Best Evidence] Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics. Dec 2008;122(6):e1268-77. [Medline].

  62. Galmiche JP, Brandstatter G, Evreux M, et al. Combined therapy with cisapride and cimetidine in severe reflux oesophagitis: a double blind controlled trial. Gut. May 1988;29(5):675-81. [Medline].

  63. Cucchiara S, Gobio-Casali L, Balli F, et al. Cimetidine treatment of reflux esophagitis in children: an Italian multicentric study. J Pediatr Gastroenterol Nutr. Feb 1989;8(2):150-6. [Medline].

  64. Simeone D, Caria MC, Miele E, Staiano A. Treatment of childhood peptic esophagitis: a double-blind placebo-controlled trial of nizatidine. J Pediatr Gastroenterol Nutr. Jul 1997;25(1):51-5. [Medline].

  65. Chiba N. Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview. Can J Gastroenterol. Sep 1997;11 Suppl B:66B-73B. [Medline].

  66. Gilger MA, Tolia V, Vandenplas Y, Youssef NN, Traxler B, Illueca M. Safety and tolerability of esomeprazole in children with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. May 2008;46(5):524-33. [Medline].

  67. Gold BD, Gunasekaran T, Tolia V, Wetzler G, Conter H, Traxler B. Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. Nov 2007;45(5):520-9. [Medline].

  68. Bishop J, Furman M, Thomson M. Omeprazole for gastroesophageal reflux disease in the first 2 years of life: a dose-finding study with dual-channel pH monitoring. J Pediatr Gastroenterol Nutr. Jul 2007;45(1):50-5. [Medline].

  69. James L, Walson P, Lomax K, Kao R, Varughese S, Reyes J. Pharmacokinetics and tolerability of rabeprazole sodium in subjects aged 12 to 16 years with gastroesophageal reflux disease: an open-label, single- and multiple-dose study. Clin Ther. Sep 2007;29(9):2082-92. [Medline].

  70. Omari T, Davidson G, Bondarov P, Nauclér E, Nilsson C, Lundborg P. Pharmacokinetics and acid-suppressive effects of esomeprazole in infants 1-24 months old with symptoms of gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. Nov 2007;45(5):530-7. [Medline].

  71. Khoshoo V, Dhume P. Clinical response to 2 dosing regimens of lansoprazole in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr. Mar 2008;46(3):352-4. [Medline].

  72. Zhang W, Kukulka M, Witt G, Sutkowski-Markmann D, North J, Atkinson S. Age-dependent pharmacokinetics of lansoprazole in neonates and infants. Paediatr Drugs. 2008;10(4):265-74. [Medline].

  73. Springer M, Atkinson S, North J, Raanan M. Safety and pharmacodynamics of lansoprazole in patients with gastroesophageal reflux disease aged < 1 year. Paediatr Drugs. 2008;10(4):255-63. [Medline].

  74. Cucchiara S, Minella R, Iervolino C, et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Arch Dis Child. Dec 1993;69(6):655-9. [Medline].

  75. Strauss RS, Calenda KA, Dayal Y, Mobassaleh M. Histological esophagitis: clinical and histological response to omeprazole in children. Dig Dis Sci. Jan 1999;44(1):134-9. [Medline].

  76. Rudolph CD. Are proton pump inhibitors indicated for the treatment of gastroesophageal reflux in infants and children?. J Pediatr Gastroenterol Nutr. Nov-Dec 2003;37 Suppl 1:S60-4. [Medline].

  77. Hassall E, Israel D, Shepherd R, et al. Omeprazole for treatment of chronic erosive esophagitis in children: a multicenter study of efficacy, safety, tolerability and dose requirements. International Pediatric Omeprazole Study Group. J Pediatr. Dec 2000;137(6):800-7. [Medline].

  78. Tolia V, Ferry G, Gunasekaran T, et al. Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children. J Pediatr Gastroenterol Nutr. 2002;35 Suppl 4:S308-18. [Medline].

  79. Rode H, Stunden RJ, Millar AJ, Cywes S. Esophageal pH assessment of gastroesophageal reflux in 18 patients and the effect of two prokinetic agents: cisapride and metoclopramide. J Pediatr Surg. Oct 1987;22(10):931-4. [Medline].

  80. Ariagno RL, Kikkert MA, Mirmiran M, et al. Cisapride decreases gastroesophageal reflux in preterm infants. Pediatrics. Apr 2001;107(4):E58. [Medline].

  81. Bozkurt M, Tutuncuoglu S, Serdaroglu G, et al. Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride. J Child Neurol. Dec 2004;19(12):973-6. [Medline].

  82. FDA. FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs. U.S. Food and Drug Administration. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149533.htm.

  83. Casteels-Van Daele M, Jaeken J, Van der Schueren P, Van den Bon P. Dystonic reactions in children caused by metoclopramide. Arch Dis Child. Feb 1970;45(239):130-3. [Medline].

  84. Low LC, Goel KM. Metoclopramide poisoning in children. Arch Dis Child. Apr 1980;55(4):310-1. [Medline].

  85. Bateman DN, Craft AW, Nicholson E, Pearson AD. Dystonic reactions and the pharmacokinetics of metoclopramide in children. Br J Clin Pharmacol. May 1983;15(5):557-9. [Medline].

  86. Keady S. Update on drugs for gastro-oesophageal reflux disease. Arch Dis Child Educ Pract Ed. Aug 2007;92(4):ep114-8. [Medline].

  87. Ng SC, Gomez JM, Rajadurai VS, Saw SM, Quak SH. Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose erythromycin. J Pediatr Gastroenterol Nutr. Nov 2003;37(5):554-8. [Medline].

  88. Wilkinson JD, Dudgeon DL, Sondheimer JM. A comparison of medical and surgical treatment of gastroesophageal reflux in severely retarded children. J Pediatr. Aug 1981;99(2):202-5. [Medline].

  89. Fonkalsrud EW, Ament ME, Berquist W. Surgical management of the gastroesophageal reflux syndrome in childhood. Surgery. Jan 1985;97(1):42-8. [Medline].

  90. Fonkalsrud EW, Berquist W, Vargas J. Surgical treatment of the gastroesophageal reflux syndrome in infants and children. Am J Surg. Jul 1987;154(1):11-8. [Medline].

  91. Boix-Ochoa J, Marhuenda C. Gastroesophageal reflux disease. In: Ashcraft KW, et al, eds. Pediatric Surgery. Philadelphia, PA: WB Saunders Co; 2000:370-89.

  92. Esposito C, Montupet P, van Der Zee D, Settimi A, Paye-Jaouen A, Centonze A. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc. Jun 2006;20(6):855-8. [Medline].

  93. Wagener S, Sudhakaran N, Cusick E. Watson fundoplication in children: a comparative study with Nissen fundoplication. J Pediatr Surg. Jun 2007;42(6):1098-102. [Medline].

  94. Bammer T, Hinder RA, Klaus A, Klingler PJ. Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg. Jan-Feb 2001;5(1):42-8. [Medline].

  95. Geiger J, Graziano K, Teitelbaum DH, et al. Recurrence after laparoscopic and open nissen fundoplication: a comparison of the true mechanisms of failure. Paper presented at: American Pediatric Surgical Association 32nd Annual Meeting; 2001.

  96. Blewett C, Hollenbeak C, Cilley R, et al. Economic implications of current surgical management of gastroesophageal reflux. Presented at: 32nd Annual Meeting of the American Pediatric Surgical Association, Naples, FL, May 20-23, 2001.

  97. Esposito C, Montupet P, Reinberg O. Laparoscopic surgery for gastroesophageal reflux disease during the first year of life. J Pediatr Surg. May 2001;36(5):715-7. [Medline].

  98. Diaz DM, Gibbons TE, Heiss K, et al. Antireflux surgery outcomes in pediatric gastroesophageal reflux disease. Am J Gastroenterol. Aug 2005;100(8):1844-52. [Medline].

  99. Esposito C, Langer JC, Schaarschmidt K, et al. Laparoscopic antireflux procedures in the management of gastroesophageal reflux following esophageal atresia repair. J Pediatr Gastroenterol Nutr. Mar 2005;40(3):349-51. [Medline].

  100. Dunn JC, Lai EC, Webber MM, et al. Long-term quantitative results following fundoplication and antroplasty for gastroesophageal reflux and delayed gastric emptying in children. Am J Surg. Jan 1998;175(1):27-9. [Medline].

  101. Fonkalsrud EW, Ellis DG, Shaw A, et al. A combined hospital experience with fundoplication and gastric emptying procedure for gastroesophageal reflux in children. J Am Coll Surg. Apr 1995;180(4):449-55. [Medline].

  102. Bustorff-Silva J, Fonkalsrud EW, Perez CA, et al. Gastric emptying procedures decrease the risk of postoperative recurrent reflux in children with delayed gastric emptying. J Pediatr Surg. Jan 1999;34(1):79-82; discussion 82-3. [Medline].

  103. Fonkalsrud EW, Ament ME, Vargas J. Gastric antroplasty for the treatment of delayed gastric emptying and gastroesophageal reflux in children. Am J Surg. Oct 1992;164(4):327-31. [Medline].

  104. Pacilli M, Pierro A, Lindley KJ, Curry JI, Eaton S. Gastric emptying is accelerated following laparoscopic Nissen fundoplication. Eur J Pediatr Surg. Dec 2008;18(6):395-7. [Medline].

  105. Gadenstatter M, Klingler A, Prommegger R, et al. Laparoscopic partial posterior fundoplication provides excellent intermediate results in GERD patients with impaired esophageal peristalsis. Surgery. Sep 1999;126(3):548-52. [Medline].

  106. Chrysos E, Tzortzinis A, Tsiaoussis J, et al. Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg. Sep 2001;182(3):215-21. [Medline].

  107. Estevao-Costa J, Campos M, Dias JA, et al. Delayed gastric emptying and gastroesophageal reflux: a pathophysiologic relationship. J Pediatr Gastroenterol Nutr. Apr 2001;32(4):471-4. [Medline].

  108. Sampson LK, Georgeson KE, Royal SA. Laparoscopic gastric antroplasty in children with delayed gastric emptying and gastroesophageal reflux. J Pediatr Surg. Feb 1998;33(2):282-5. [Medline].

  109. Smith CD, Othersen HB, Gogan NJ, Walker JD. Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals. Ann Surg. Jun 1992;215(6):654-8; discussion 658-9. [Medline].

  110. Lee SL, Sydorak RM, Chiu VY, Hsu JW, Applebaum H, Haigh PI. Long-term antireflux medication use following pediatric Nissen fundoplication. Arch Surg. Sep 2008;143(9):873-6; discussion 876. [Medline].

  111. Ravelli AM, Milla PJ. Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr. Jan 1998;26(1):56-63. [Medline].

  112. Richards CA, Andrews PL, Spitz L, Milla PJ. Nissen fundoplication may induce gastric myoelectrical disturbance in children. J Pediatr Surg. Dec 1998;33(12):1801-5. [Medline].

  113. Celik A, Loux TJ, Harmon CM, Saito JM, Georgeson KE, Barnhart DC. Revision Nissen fundoplication can be completed laparoscopically with a low rate of complications: a single-institution experience with 72 children. J Pediatr Surg. Dec 2006;41(12):2081-5. [Medline].

  114. Danielson PD, Emmens RW. Esophagogastric disconnection for gastroesophageal reflux in children with severe neurological impairment. J Pediatr Surg. Jan 1999;34(1):84-6; discussion 87. [Medline].

  115. Goyal A, Khalil B, Choo K, et al. Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?. J Pediatr Surg. Jun 2005;40(6):915-8; discussion 918-9. [Medline].

  116. Buratti S, Kamenwa R, Dohil R, et al. Esophagogastric disconnection following failed fundoplication for the treatment of gastroesophageal reflux disease (GERD) in children with severe neurological impairment. Pediatr Surg Int. Oct 2004;20(10):786-90. [Medline].

  117. Hassall E. Outcomes of fundoplication: causes for concern, newer options. Arch Dis Child. Oct 2005;90(10):1047-52. [Medline].

  118. Goldin AB, Sawin R, Seidel KD, Flum DR. Do antireflux operations decrease the rate of reflux-related hospitalizations in children?. Pediatrics. Dec 2006;118(6):2326-33. [Medline].

  119. Turnage RH, Oldham KT, Coran AG, Blane CE. Late results of fundoplication for gastroesophageal reflux in infants and children. Surgery. Apr 1989;105(4):457-64. [Medline].

  120. Subramaniam R, Dickson AP. Long-term outcome of Boix-Ochoa and Nissen fundoplication in normal and neurologically impaired children. J Pediatr Surg. Aug 2000;35(8):1214-6. [Medline].

  121. Triadafilopoulos G, DiBaise JK, Nostrant TT, et al. The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc. Feb 2002;55(2):149-56. [Medline].

  122. Richards WO, Houston HL, Torquati A, et al. Paradigm shift in the management of gastroesophageal reflux disease. Ann Surg. May 2003;237(5):638-47; discussion 648-9. [Medline].

  123. Islam S, Geiger JD, Coran AG, Teitelbaum DH. Use of radiofrequency ablation of the lower esophageal sphincter to treat recurrent gastroesophageal reflux disease. J Pediatr Surg. Mar 2004;39(3):282-6; discussion 282-6. [Medline].

  124. Mahmood Z, McMahon BP, Arfin Q, et al. Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up. Gut. Jan 2003;52(1):34-9. [Medline]. [Full Text].

  125. Strople J, Kaul A. Pediatric gastroesophageal reflux disease--current perspectives. Curr Opin Otolaryngol Head Neck Surg. Dec 2003;11(6):447-51. [Medline].

  126. Thomson M, Fritscher-Ravens A, Hall S, et al. Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease. Gut. Dec 2004;53(12):1745-50. [Medline]. [Full Text].

  127. Knight CG, Lorincz A, Gidell KM, et al. Computer-assisted robot-enhanced laparoscopic fundoplication in children. J Pediatr Surg. Jun 2004;39(6):864-6; discussion 864-6. [Medline].

  128. Lehnert M, Richter B, Beyer PA, Heller K. A prospective study comparing operative time in conventional laparoscopic and robotically assisted Thal semifundoplication in children. J Pediatr Surg. Aug 2006;41(8):1392-6. [Medline].

  129. Cunningham KM, Horowitz M, Riddell PS, et al. Relations among autonomic nerve dysfunction, oesophageal motility, and gastric emptying in gastro-oesophageal reflux disease. Gut. Dec 1991;32(12):1436-40. [Medline].

  130. Esposito C, Becmeur F, Centonze A, et al. Laparoscopic reoperation following unsuccessful antireflux surgery in childhood. Semin Laparosc Surg. Sep 2002;9(3):177-9. [Medline].

  131. Houston H, Khaitan L, Holzman M, Richards WO. First year experience of patients undergoing the Stretta procedure. Surg Endosc. Mar 2003;17(3):401-4. [Medline].

  132. Hui JM, Hunt DR, de Carle DJ, et al. Esophageal pneumatic dilation for postfundoplication dysphagia: safety, efficacy, and predictors of outcome. Am J Gastroenterol. Dec 2002;97(12):2986-91. [Medline].

  133. Kawahara H, Okuyama H, Kubota A, et al. Can laparoscopic antireflux surgery improve the quality of life in children with neurologic and neuromuscular handicaps?. J Pediatr Surg. Dec 2004;39(12):1761-4. [Medline].

  134. Klinkenberg-Knol EC, Jansen JM, Festen HP, et al. Double-blind multicentre comparison of omeprazole and ranitidine in the treatment of reflux oesophagitis. Lancet. Feb 14 1987;1(8529):349-51. [Medline].

  135. Lima M, Bertozzi M, Ruggeri G, et al. Laparoscopic antireflux surgery in neurologically impaired children. Pediatr Surg Int. Feb 2004;20(2):114-7. [Medline].

  136. Malhi-Chowla N, Gorecki P, Bammer T, et al. Dilation after fundoplication: timing, frequency, indications, and outcome. Gastrointest Endosc. Feb 2002;55(2):219-23. [Medline].

  137. Mattioli G, Esposito C, Lima M, et al. Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children. Surg Endosc. Dec 2002;16(12):1666-8. [Medline].

  138. Orenstein SR, Cohn JF, Shalaby TM, Kartan R. Reliability and validity of an infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila). Aug 1993;32(8):472-84. [Medline].

  139. Stahl RA, Thaiss F, Wenzel U, et al. A rat model of progressive chronic glomerular sclerosis: the role of thromboxane inhibition. J Am Soc Nephrol. May 1992;2(11):1568-77. [Medline].

  140. Suskind DL, Thompson DM, Gulati M, et al. Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation?. Laryngoscope. Aug 2006;116(8):1397-403. [Medline].

  141. Tew S, Ackroyd R, Jamieson GG, Holloway RH. Belching and bloating: facts and fantasy after antireflux surgery. Br J Surg. Apr 2000;87(4):477-81. [Medline].

  142. van der Zee DC, Arends NJ, Bax NM. The value of 24-h pH study in evaluating the results of laparoscopic antireflux surgery in children. Surg Endosc. Sep 1999;13(9):918-21. [Medline].

  143. Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. Oct 1991;88(4):834-40. [Medline].

  144. Weber TR. A prospective analysis of factors influencing outcome after fundoplication. J Pediatr Surg. Jul 1995;30(7):1061-3; discussion 1063-4. [Medline].

 
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Relationship of the phrenoesophageal ligament to the diaphragm and esophagus.
Arterial blood supply and lymphatic drainage of the esophagus.
Nissen fundoplication.
Toupet partial fundoplication.
 
 
 
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