Pediatric Gastroesophageal Reflux Surgery Workup

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

Imaging Studies

  • An upper GI barium study, although no longer the diagnostic study of choice, may be useful in the evaluation of gastroesophageal reflux disease (GERD) when performed by an experienced pediatric radiologist. The sensitivity of this study in diagnosing the occurrence of reflux and the presence of esophagitis is low,[47] but esophageal motility and anatomic abnormalities (eg, hiatal hernia, stricture, malrotation) may be identified.
  • Gastric emptying (GE) scintigraphy (milk scan) involves ingestion of a radiolabeled meal (historically, radiolabeled milk), with serial images recorded up to 60 minutes after ingestion. This study may be used to diagnose and quantitate reflux but is primarily used to assess gastric emptying and to identify delayed GE. Late images showing isotope in the lungs indicate pulmonary aspiration.
  • Both an upper GI barium study and GE scintigraphy may be helpful in the diagnosis of GER but are not sensitive. The primary diagnostic tool for GER today is the pH probe study. Impedance/pH monitoring is currently under investigation as a potentially superior diagnostic modality.
Next

Other Tests

The 24-hour pH probe monitor is the standard diagnostic test for GER.

  • Originally described by Johnson and De Meester in 1974, a catheter at the LES measures episodes of reflux over a 24-hour period.
  • An esophageal intraluminal pH of less than 4.0 for at least 15 seconds defines an episode of reflux.
  • Recorded values include total time with pH below 4.0, upright time with pH less than 4.0, supine time with pH less than 4.0, number of reflux episodes longer than 5 minutes, and duration of the longest reflux episode.
  • A composite score is calculated based on these results.
  • This test has since been evaluated and validated in children.[48, 49]
  • This test is more sensitive and specific for acid reflux than barium esophagraphy.[47]
  • Disadvantages of 24-hour pH probe include the inability to diagnose nonacid reflux and to distinguish primary and secondary (allergy to milk protein or other food) causes of reflux,[50] the inability to determine the presence or severity of esophagitis, and poor tolerance of the probe in some children.

Esophageal impedance/pH monitoring is a novel technique that can be used to detect both acid and nonacid reflux.

  • This test uses a probe similar to that used in standard pH monitoring to measure the change in electrical resistance that occurs across its sensors with the passage of intraluminal material.
  • Advantages of this test include the ability to identify the content, direction, and localization of any reflux.[51] This test may yield better diagnostic sensitivity than pH probe in patients treated with antacids.
  • Disadvantages include a lack of standardized pediatric normal ranges[52] and increased cost relative to standard pH probe.[51]

Esophageal manometry is used to assess the contractility of the esophageal body and sphincters (UES and LES).

  • Although not diagnostic for GER, this study may reveal LES hypotension in the setting of reflux or abnormal peristalsis in patients with esophageal dysmotility or severe esophagitis.
  • Esophageal manometry may also be used to identify children with motility disorders in whom antireflux surgery would be contraindicated (see Contraindications).
  • At least one study has found no correlation between motility pattern and outcome and does not advocate routine use of this study.[53]
Previous
Next

Diagnostic Procedures

  • Endoscopy is used to visualize and obtain a biopsy sample from the esophageal mucosa and to diagnose esophagitis, stricture, and Barrett esophagus.
  • Although there is no validated grading system for children, erosion or ulceration is indicative of esophagitis.
  • Biopsy should be performed in most cases, even if the mucosa appears relatively normal, because there is a significant tendency for histologic grade to exceed visual endoscopic findings.[54]
  • Endoscopic ultrasonography has been described as an adjunct to endoscopy to evaluate the integrity of Nissen fundoplication in children and adults.[55]
Previous
Next

Histologic Findings

Endoscopic biopsy may be used to diagnose esophagitis or Barrett esophagus. Infiltration of neutrophils and eosinophils, papillary hyperplasia, and basal-zone thickening are all linked to the diagnosis of GERD.[56] Barrett esophagus is characterized by intestinal metaplasia of the esophageal mucosa; columnar intestinal epithelium and goblet cells replace the normal squamous epithelial lining of the esophagus. In children with chronic aspiration, lipid-laden macrophages may be visible in bronchoalveolar-lavage specimens.

Previous
Proceed to Treatment & Management
 
 
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].

 
Previous
Next
 
Relationship of the phrenoesophageal ligament to the diaphragm and esophagus.
Arterial blood supply and lymphatic drainage of the esophagus.
Nissen fundoplication.
Toupet partial fundoplication.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.