History and Physical Examination

Many healthy infants have physiologic reflux. Approximately 40% of healthy infants have at least one episode of emesis a day, with more than 5 mL of nonbilious emesis per episode.^{[39, 40]}These minor reflux episodes (spit-ups) usually resolve by the time the patient reaches the age of 6 months and do not cause any serious sequelae. In some children, gastroesophageal reflux (GER) is pathologic, leading to irritability, apnea, recurrent pneumonia, respiratory dysfunction, esophagitis, or failure to thrive.

Generally, a thorough history and a careful physical examination elicit signs and symptoms of reflux. In addition, an infant or child may have a history of frequent emesis, aspiration events, asthma, or feeding difficulty. A careful assessment of growth parameters and nutritional status is an important component of the physical examination and preoperative evaluation. Because one of the indications for antireflux surgery is failure to thrive, operative candidates may be malnourished.

The presenting symptoms of gastroesophageal reflux disease (GERD) in infants and children differ from those seen in adults and vary with age. Anorexia and feeding difficulty correlate with erosive esophagitis on endoscopy and are common presentations in children aged 1-5 years.^[41]Infants may present with frequent regurgitation in addition to feeding difficulties.^[42]

Feeding difficulties in infants were evaluated in a study investigating the clinical outcomes of GERD treatment.^[43]According to a retrospective review of 28 infants with feeding difficulty prior to GERD treatment, posttreatment evaluation with both endoscopy and videofluoroscopy demonstrated marked functional improvement in infant swallowing.

GERD has been closely linked to respiratory problems due to recurrent aspiration of gastric contents.^[44]A Pediatric Health Information System Database analysis of 12,067 patients found that GERD was the most common discharge diagnosis in patients admitted with an apparent life-threatening event.^[45]Reflux should also be ruled out in a child with recurrent pneumonia or chronic nocturnal cough. Considerable controversy remains as to whether GERD is causally or temporally associated with sudden infant death syndrome (SIDS).^{[46, 47]}

The relationship of GERD with childhood asthma is more defined, and the prevalence is thought to be 40-60%.^{[48, 49]}In a prospective evaluation of pediatric patients with GER and asthma, investigators demonstrated a significant reduction in the use of bronchodilators and inhaled steroids after treatment for reflux disease. This effect was not seen in control patients with asthma and no diagnosis of GER.^[50]

Some authors dispute the association between GER and lung disease.^[51]The use of multichannel intraluminal impedance has permitted further investigation into the role of nonacid reflux in the pathogenesis of GER-related respiratory disease. An examination of 28 children with persistent respiratory symptoms despite antacid therapy demonstrated that symptoms were more frequently associated with nonacid reflux.^[52]

A follow-up study of 24 children with asthma found a higher correlation between asthma and reflux detected by impedance (which is able to detect both acid and nonacid reflux) in comparison with detection by pH probe alone (acid reflux).^[53]

Esophageal mucosal damage from gastric acid exposure is common in patients with GERD and can lead to esophagitis or esophageal stricture. Barrett esophagus, a premalignant process characterized by replacement of the normal squamous cells of the lower esophagus with columnar cells typically found in the stomach, has been linked to chronic reflux in older children. It has been surmised that this metaplasia is due to constant acid exposure during times of healing.^[54]Barrett esophagus necessitates serial follow-up with endoscopy and biopsy.

Workup

Blanco FC, Davenport KP, Kane TD. Pediatric gastroesophageal reflux disease. Surg Clin North Am. 2012 Jun. 92 (3):541-58, viii. [QxMD MEDLINE Link].
Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context. 2019. 8:212591. [QxMD MEDLINE Link]. [Full Text].
Rosen R. Novel Advances in the Evaluation and Treatment of Children With Symptoms of Gastroesophageal Reflux Disease. Front Pediatr. 2022. 10:849105. [QxMD MEDLINE Link]. [Full Text].
Boerema I. Hiatus hernia: repair by right-sided, subhepatic, anterior gastropexy. Surgery. 1969 Jun. 65 (6):884-93. [QxMD MEDLINE Link].
Allison PR. Hiatus hernia: (a 20-year retrospective survey). Ann Surg. 1973 Sep. 178 (3):273-6. [QxMD MEDLINE Link].
Varshney S, Kelly JJ, Branagan G, Somers SS, Kelly JM. Angelchik prosthesis revisited. World J Surg. 2002 Jan. 26 (1):129-33. [QxMD MEDLINE Link].
Nissen R, Rossetti M, Siewert R. [20 years in the management of reflux disease using fundoplication]. Chirurg. 1977 Oct. 48 (10):634-9. [QxMD MEDLINE Link].
Kazerooni NL, VanCamp J, Hirschl RB, Drongowski RA, Coran AG. Fundoplication in 160 children under 2 years of age. J Pediatr Surg. 1994 May. 29 (5):677-81. [QxMD MEDLINE Link].
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc. 1991 Sep. 1 (3):138-43. [QxMD MEDLINE Link].
Nilsson G, Larsson S, Johnsson F. Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period. Br J Surg. 2000 Jul. 87 (7):873-8. [QxMD MEDLINE Link].
Wenner J, Nilsson G, Oberg S, Melin T, Larsson S, Johnsson F. Short-term outcome after laparoscopic and open 360 degrees fundoplication. A prospective randomized trial. Surg Endosc. 2001 Oct. 15 (10):1124-8. [QxMD MEDLINE Link].
Somme S, Rodriguez JA, Kirsch DG, Liu DC. Laparoscopic versus open fundoplication in infants. Surg Endosc. 2002 Jan. 16 (1):54-6. [QxMD MEDLINE Link].
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. 2003 Oct. 38 (10):1429-33. [QxMD MEDLINE Link].
Rothenberg SS. The first decade's experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg. 2005 Jan. 40 (1):142-6; discussion 147. [QxMD MEDLINE Link].
Rosales A, Whitehouse J, Laituri C, Herbello G, Long J. Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience. Pediatr Surg Int. 2018 Jul. 34 (7):749-754. [QxMD MEDLINE Link].
Mittal RK, Rochester DF, McCallum RW. Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans. Am J Physiol. 1989 Jan. 256 (1 Pt 1):G139-44. [QxMD MEDLINE Link].
Mittal RK, McCallum RW. Characteristics of transient lower esophageal sphincter relaxation in humans. Am J Physiol. 1987 May. 252 (5 Pt 1):G636-41. [QxMD MEDLINE Link].
Mittal RK, Rochester DF, McCallum RW. Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man. Gut. 1987 Dec. 28 (12):1564-8. [QxMD MEDLINE Link].
Omari TI, Barnett C, Snel A, Goldsworthy W, Haslam R, Davidson G, et al. Mechanisms of gastroesophageal reflux in healthy premature infants. J Pediatr. 1998 Nov. 133 (5):650-4. [QxMD MEDLINE Link].
Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology. 1997 Aug. 113 (2):399-408. [QxMD MEDLINE Link].
Chitkara DK, Fortunato C, Nurko S. Esophageal motor activity in children with gastro-esophageal reflux disease and esophagitis. J Pediatr Gastroenterol Nutr. 2005 Jan. 40 (1):70-5. [QxMD MEDLINE Link].
O'Sullivan GC, DeMeester TR, Joelsson BE, Smith RB, Blough RR, Johnson LF, et al. Interaction of lower esophageal sphincter pressure and length of sphincter in the abdomen as determinants of gastroesophageal competence. Am J Surg. 1982 Jan. 143 (1):40-7. [QxMD MEDLINE Link].
Winans CS, Harris LD. Quantitation of lower esophageal sphincter competence. Gastroenterology. 1967 May. 52 (5):773-8. [QxMD MEDLINE Link].
Halpern LM, Jolley SG, Johnson DG. Gastroesophageal reflux: a significant association with central nervous system disease in children. J Pediatr Surg. 1991 Feb. 26 (2):171-3. [QxMD MEDLINE Link].
Konkin DE, O'hali WA, Webber EM, Blair GK. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2003 Dec. 38 (12):1726-9. [QxMD MEDLINE Link].
Little DC, Rescorla FJ, Grosfeld JL, West KW, Scherer LR, Engum SA. Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2003 Jun. 38 (6):852-6. [QxMD MEDLINE Link].
Banjar HH, Al-Nassar SI. Gastroesophageal reflux following repair of esophageal atresia and tracheoesophageal fistula. Saudi Med J. 2005 May. 26 (5):781-5. [QxMD MEDLINE Link].
Koch A, Rohr S, Plaschkes J, Bettex M. Incidence of gastroesophageal reflux following repair of esophageal atresia. Prog Pediatr Surg. 1986. 19:103-13. [QxMD MEDLINE Link].
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. 1997 Jun. 151 (6):569-72. [QxMD MEDLINE Link].
Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics. 1998 Dec. 102 (6):E67. [QxMD MEDLINE Link].
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. 2003 Nov-Dec. 37 Suppl 1:S33-9. [QxMD MEDLINE Link].
Pearl RH, Robie DK, Ein SH, Shandling B, Wesson DE, Superina R, et al. Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal children. J Pediatr Surg. 1990 Nov. 25 (11):1169-73. [QxMD MEDLINE Link].
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. 2006 Dec. 41 (12):2081-5. [QxMD MEDLINE Link].
Danielson PD, Emmens RW. Esophagogastric disconnection for gastroesophageal reflux in children with severe neurological impairment. J Pediatr Surg. 1999 Jan. 34 (1):84-6; discussion 87. [QxMD MEDLINE Link].
Goyal A, Khalil B, Choo K, Mohammed K, Jones M. Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?. J Pediatr Surg. 2005 Jun. 40 (6):915-8; discussion 918-9. [QxMD MEDLINE Link].
Buratti S, Kamenwa R, Dohil R, Collins D, Lavine JE. Esophagogastric disconnection following failed fundoplication for the treatment of gastroesophageal reflux disease (GERD) in children with severe neurological impairment. Pediatr Surg Int. 2004 Oct. 20 (10):786-90. [QxMD MEDLINE Link].
Koivusalo AI, Pakarinen MP. Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients. Scand J Surg. 2018 Mar. 107 (1):68-75. [QxMD MEDLINE Link].
Banerjee DB, Parekh P, Cross K, Blackburn S, Roebuck DJ, Curry J, et al. Long-term outcomes following failure of Nissen fundoplication. Pediatr Surg Int. 2022 May. 38 (5):707-712. [QxMD MEDLINE Link].
Orenstein SR. Esophageal disorders in infants and children. Curr Opin Pediatr. 1993 Oct. 5 (5):580-9. [QxMD MEDLINE Link].
Orenstein SR, Shalaby TM, Cohn JF. Reflux symptoms in 100 normal infants: diagnostic validity of the infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila). 1996 Dec. 35 (12):607-14. [QxMD MEDLINE Link].
Gupta SK, Hassall E, Chiu YL, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci. 2006 May. 51 (5):858-63. [QxMD MEDLINE Link].
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. 2006 Mar. 42 (3):134-9. [QxMD MEDLINE Link].
Suskind DL, Thompson DM, Gulati M, Huddleston P, Liu DC, Baroody FM. Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation?. Laryngoscope. 2006 Aug. 116 (8):1397-403. [QxMD MEDLINE Link].
Euler AR, Byrne WJ, Ament ME, Fonkalsrud EW, Strobel CT, Siegel SC, et al. Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. Pediatrics. 1979 Jan. 63 (1):47-51. [QxMD MEDLINE Link].
Tieder JS, Cowan CA, Garrison MM, Christakis DA. Variation in inpatient resource utilization and management of apparent life-threatening events. J Pediatr. 2008 May. 152 (5):629-35, 635.e1-2. [QxMD MEDLINE Link].
Amin RS. Gastroesophageal reflux and infant apnea. J Pediatr. 2000 Sep. 137 (3):298-300. [QxMD MEDLINE Link].
Alex N, Thompson JM, Becroft DM, Mitchell EA. Pulmonary aspiration of gastric contents and the sudden infant death syndrome. J Paediatr Child Health. 2005 Aug. 41 (8):428-31. [QxMD MEDLINE Link].
Faubion WA Jr, Zein NN. Gastroesophageal reflux in infants and children. Mayo Clin Proc. 1998 Feb. 73 (2):166-73. [QxMD MEDLINE Link].
Yüksel H, Yilmaz O, Kirmaz C, Aydoğdu S, Kasirga E. Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease. Respir Med. 2006 Mar. 100 (3):393-8. [QxMD MEDLINE Link].
Khoshoo V, Le T, Haydel RM Jr, Landry L, Nelson C. Role of gastroesophageal reflux in older children with persistent asthma. Chest. 2003 Apr. 123 (4):1008-13. [QxMD MEDLINE Link].
Weinberger M. Gastroesophageal reflux disease is not a significant cause of lung disease in children. Pediatr Pulmonol Suppl. 2004. 26:197-200. [QxMD MEDLINE Link].
Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. 2004 Dec. 99 (12):2452-8. [QxMD MEDLINE Link].
Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O'Connor JA. Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring. J Pediatr. 2006 Aug. 149 (2):216-9. [QxMD MEDLINE Link].
Hassall E. Barrett's esophagus: congenital or acquired?. Am J Gastroenterol. 1993 Jun. 88 (6):819-24. [QxMD MEDLINE Link].
Al-Khawari HA, Sinan TS, Seymour H. Diagnosis of gastro-oesophageal reflux in children. Comparison between oesophageal pH and barium examinations. Pediatr Radiol. 2002 Nov. 32 (11):765-70. [QxMD MEDLINE Link].
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. 2007 Sep. 39 (9):864-71. [QxMD MEDLINE Link].
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. 2007 Oct. 21 (10):1719-25. [QxMD MEDLINE Link].
Chen S, Jarboe MD, Teitelbaum DH. Effectiveness of a transluminal endoscopic fundoplication for the treatment of pediatric gastroesophageal reflux disease. Pediatr Surg Int. 2012 Mar. 28 (3):229-34. [QxMD MEDLINE Link].
Okada T, Honda S, Miyagi H, Minato M. Nissen fundoplication for gastroesophageal reflux: No deterioration of gastric emptying measured by C-acetate breath test. J Indian Assoc Pediatr Surg. 2011 Oct. 16 (4):137-41. [QxMD MEDLINE Link]. [Full Text].
Boix-Ochoa J, Lafuenta JM, Gil-Vernet JM. Twenty-four hour exophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg. 1980 Feb. 15 (1):74-8. [QxMD MEDLINE Link].
Sondheimer JM. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr. 1980 May. 96 (5):804-7. [QxMD MEDLINE Link].
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. 2007 Oct 14. 13 (38):5108-15. [QxMD MEDLINE Link].
Vandenplas Y, Salvatore S, Vieira MC, Hauser B. Will esophageal impedance replace pH monitoring?. Pediatrics. 2007 Jan. 119 (1):118-22. [QxMD MEDLINE Link].
Mattioli G, Pini-Prato A, Gentilino V, Caponcelli E, Avanzini S, Parodi S, et al. Esophageal impedance/pH monitoring in pediatric patients: preliminary experience with 50 cases. Dig Dis Sci. 2006 Dec. 51 (12):2341-7. [QxMD MEDLINE Link].
Mattioli G, Gentilino V, Caponcelli E, Martino F, Castagnetti M, Pini Prato A, et al. Effectiveness of esophageal manometry in predicting the outcome of children with primary GER after floppy Nissen-Rossetti wrap. Surg Endosc. 2004 Oct. 18 (10):1504-8. [QxMD MEDLINE Link].
Winter HS, Madara JL, Stafford RJ, Grand RJ, Quinlan JE, Goldman H. Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology. 1982 Oct. 83 (4):818-23. [QxMD MEDLINE Link].
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. 2005 Oct. 19 (10):1309-14. [QxMD MEDLINE Link].
[Guideline] Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar. 66 (3):516-554. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, et al. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc. 2021 Sep. 35 (9):4903-4917. [QxMD MEDLINE Link]. [Full Text].
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. 2007 Dec. 151 (6):591-6, 596.e1. [QxMD MEDLINE Link].
van Wijk MP, Benninga MA, Dent J, Lontis R, Goodchild L, McCall LM, et al. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. 2007 Dec. 151 (6):585-90, 590.e1-2. [QxMD MEDLINE Link].
Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr. 2008 Mar. 152 (3):310-4. [QxMD MEDLINE Link].
Salvatore S, Savino F, Singendonk M, Tabbers M, Benninga MA, Staiano A, et al. Thickened infant formula: What to know. Nutrition. 2018 May. 49:51-56. [QxMD MEDLINE Link].
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. 2008 Dec. 122 (6):e1268-77. [QxMD MEDLINE Link].
Galmiche JP, Brandstätter G, Evreux M, Hentschel E, Kerstan E, Kratochvil P, et al. Combined therapy with cisapride and cimetidine in severe reflux oesophagitis: a double blind controlled trial. Gut. 1988 May. 29 (5):675-81. [QxMD MEDLINE Link].
Cucchiara S, Gobio-Casali L, Balli F, Magazzú G, Staiano A, Astolfi R, et al. Cimetidine treatment of reflux esophagitis in children: an Italian multicentric study. J Pediatr Gastroenterol Nutr. 1989 Feb. 8 (2):150-6. [QxMD MEDLINE Link].
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. 1997 Jul. 25 (1):51-5. [QxMD MEDLINE Link].
Chiba N. Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview. Can J Gastroenterol. 1997 Sep. 11 Suppl B:66B-73B. [QxMD MEDLINE Link].
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. 2008 May. 46 (5):524-33. [QxMD MEDLINE Link].
Gold BD, Gunasekaran T, Tolia V, Wetzler G, Conter H, Traxler B, et al. Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007 Nov. 45 (5):520-9. [QxMD MEDLINE Link].
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. 2007 Jul. 45 (1):50-5. [QxMD MEDLINE Link].
James L, Walson P, Lomax K, Kao R, Varughese S, Reyes J, et al. 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. 2007 Sep. 29 (9):2082-92. [QxMD MEDLINE Link].
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. 2007 Nov. 45 (5):530-7. [QxMD MEDLINE Link].
Khoshoo V, Dhume P. Clinical response to 2 dosing regimens of lansoprazole in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2008 Mar. 46 (3):352-4. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Springer M, Atkinson S, North J, Raanan M. Safety and pharmacodynamics of lansoprazole in patients with gastroesophageal reflux disease aged Paediatr Drugs</i>. 2008. 10 (4):255-63. [QxMD MEDLINE Link].
Cucchiara S, Minella R, Iervolino C, Franco MT, Campanozzi A, Franceschi M, et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Arch Dis Child. 1993 Dec. 69 (6):655-9. [QxMD MEDLINE Link].
Strauss RS, Calenda KA, Dayal Y, Mobassaleh M. Histological esophagitis: clinical and histological response to omeprazole in children. Dig Dis Sci. 1999 Jan. 44 (1):134-9. [QxMD MEDLINE Link].
Rudolph CD. Are proton pump inhibitors indicated for the treatment of gastroesophageal reflux in infants and children?. J Pediatr Gastroenterol Nutr. 2003 Nov-Dec. 37 Suppl 1:S60-4. [QxMD MEDLINE Link].
Hassall E, Israel D, Shepherd R, Radke M, Dalväg A, Sköld B, 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. 2000 Dec. 137 (6):800-7. [QxMD MEDLINE Link].
Tolia V, Ferry G, Gunasekaran T, Huang B, Keith R, Book L. Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children. J Pediatr Gastroenterol Nutr. 2002. 35 Suppl 4:S308-18. [QxMD MEDLINE Link].
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. 1987 Oct. 22 (10):931-4. [QxMD MEDLINE Link].
Ariagno RL, Kikkert MA, Mirmiran M, Conrad C, Baldwin RB. Cisapride decreases gastroesophageal reflux in preterm infants. Pediatrics. 2001 Apr. 107 (4):E58. [QxMD MEDLINE Link].
Bozkurt M, Tutuncuoglu S, Serdaroglu G, Tekgul H, Aydogdu S. Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride. J Child Neurol. 2004 Dec. 19 (12):973-6. [QxMD MEDLINE Link].
Casteels-Van Daele M, Jaeken J, Van der Schueren P, Van den Bon P. Dystonic reactions in children caused by metoclopramide. Arch Dis Child. 1970 Feb. 45 (239):130-3. [QxMD MEDLINE Link].
Low LC, Goel KM. Metoclopramide poisoning in children. Arch Dis Child. 1980 Apr. 55 (4):310-2. [QxMD MEDLINE Link].
Bateman DN, Craft AW, Nicholson E, Pearson AD. Dystonic reactions and the pharmacokinetics of metoclopramide in children. Br J Clin Pharmacol. 1983 May. 15 (5):557-9. [QxMD MEDLINE Link].
Keady S. Update on drugs for gastro-oesophageal reflux disease. Arch Dis Child Educ Pract Ed. 2007 Aug. 92 (4):ep114-8. [QxMD MEDLINE Link].
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. 2003 Nov. 37 (5):554-8. [QxMD MEDLINE Link].
Wilkinson JD, Dudgeon DL, Sondheimer JM. A comparison of medical and surgical treatment of gastroesophageal reflux in severely retarded children. J Pediatr. 1981 Aug. 99 (2):202-5. [QxMD MEDLINE Link].
Fonkalsrud EW, Ament ME, Berquist W. Surgical management of the gastroesophageal reflux syndrome in childhood. Surgery. 1985 Jan. 97 (1):42-8. [QxMD MEDLINE Link].
Fonkalsrud EW, Berquist W, Vargas J, Ament ME, Foglia RP. Surgical treatment of the gastroesophageal reflux syndrome in infants and children. Am J Surg. 1987 Jul. 154 (1):11-8. [QxMD MEDLINE Link].
Holcomb GW III. Gastroesophageal reflux. Holcomb GW III, Murphy JP, St Peter SD, eds. Holcomb and Ashcraft's Pediatric Surgery. 7th ed. Philadelphia: Elsevier; 2020. 460-77.
Gezer HÖ, Ezer SS, Temiz A, İnce E, Hiçsönmez A. Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of "Gold Standard" from Total Fundoplication?. J Gastrointest Surg. 2019 Dec. 23 (12):2338-2345. [QxMD MEDLINE Link].
Esposito C, Montupet P, van Der Zee D, Settimi A, Paye-Jaouen A, Centonze A, et al. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc. 2006 Jun. 20 (6):855-8. [QxMD MEDLINE Link].
Wagener S, Sudhakaran N, Cusick E. Watson fundoplication in children: a comparative study with Nissen fundoplication. J Pediatr Surg. 2007 Jun. 42 (6):1098-102. [QxMD MEDLINE Link].
Glen P, Chassé M, Doyle MA, Nasr A, Fergusson DA. Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis. PLoS One. 2014. 9 (11):e112417. [QxMD MEDLINE Link]. [Full Text].
Till H, Esposito C, Escolino M, Singer G, Gasparella P, Arneitz C. Laparoscopic Treatment of Gastroesophageal Reflux Disease in Children: How We Do It. J Laparoendosc Adv Surg Tech A. 2021 Oct. 31 (10):1175-1179. [QxMD MEDLINE Link].
Bammer T, Hinder RA, Klaus A, Klingler PJ. Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg. 2001 Jan-Feb. 5 (1):42-8. [QxMD MEDLINE Link].
Esposito C, Saxena A, Irtan S, Till H, Escolino M. Laparoscopic Nissen Fundoplication: An Excellent Treatment of GERD-Related Respiratory Symptoms in Children-Results of a Multicentric Study. J Laparoendosc Adv Surg Tech A. 2018 Aug. 28 (8):1023-1028. [QxMD MEDLINE Link].
Esposito C, Montupet P, Reinberg O. Laparoscopic surgery for gastroesophageal reflux disease during the first year of life. J Pediatr Surg. 2001 May. 36 (5):715-7. [QxMD MEDLINE Link].
Diaz DM, Gibbons TE, Heiss K, Wulkan ML, Ricketts RR, Gold BD. Antireflux surgery outcomes in pediatric gastroesophageal reflux disease. Am J Gastroenterol. 2005 Aug. 100 (8):1844-52. [QxMD MEDLINE Link].
Esposito C, Langer JC, Schaarschmidt K, Mattioli G, Sauer C, Centonze A, et al. Laparoscopic antireflux procedures in the management of gastroesophageal reflux following esophageal atresia repair. J Pediatr Gastroenterol Nutr. 2005 Mar. 40 (3):349-51. [QxMD MEDLINE Link].
Hill SJ, Pandya S, Clifton MS, Bhatia A, Wulkan ML. Cardiaplication: a novel surgical technique for refractory gastroesophageal reflux in the pediatric population. J Laparoendosc Adv Surg Tech A. 2011 Nov. 21 (9):873-5. [QxMD MEDLINE Link].
Dunn JC, Lai EC, Webber MM, Ament ME, Fonkalsrud EW. Long-term quantitative results following fundoplication and antroplasty for gastroesophageal reflux and delayed gastric emptying in children. Am J Surg. 1998 Jan. 175 (1):27-9. [QxMD MEDLINE Link].
Fonkalsrud EW, Ellis DG, Shaw A, Mann CM Jr, Black TL, Miller JP, et al. A combined hospital experience with fundoplication and gastric emptying procedure for gastroesophageal reflux in children. J Am Coll Surg. 1995 Apr. 180 (4):449-55. [QxMD MEDLINE Link].
Bustorff-Silva J, Fonkalsrud EW, Perez CA, Quintero R, Martin L, Villasenor E, et al. Gastric emptying procedures decrease the risk of postoperative recurrent reflux in children with delayed gastric emptying. J Pediatr Surg. 1999 Jan. 34 (1):79-82; discussion 82-3. [QxMD MEDLINE Link].
Fonkalsrud EW, Ament ME, Vargas J. Gastric antroplasty for the treatment of delayed gastric emptying and gastroesophageal reflux in children. Am J Surg. 1992 Oct. 164 (4):327-31. [QxMD MEDLINE Link].
Pacilli M, Pierro A, Lindley KJ, Curry JI, Eaton S. Gastric emptying is accelerated following laparoscopic Nissen fundoplication. Eur J Pediatr Surg. 2008 Dec. 18 (6):395-7. [QxMD MEDLINE Link].
Gadenstätter M, Klingler A, Prommegger R, Hinder RA, Wetscher GJ. Laparoscopic partial posterior fundoplication provides excellent intermediate results in GERD patients with impaired esophageal peristalsis. Surgery. 1999 Sep. 126 (3):548-52. [QxMD MEDLINE Link].
Chrysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Vasssilakis J, Xynos E. Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg. 2001 Sep. 182 (3):215-21. [QxMD MEDLINE Link].
Estevão-Costa J, Campos M, Dias JA, Trindade E, Medina AM, Carvalho JL. Delayed gastric emptying and gastroesophageal reflux: a pathophysiologic relationship. J Pediatr Gastroenterol Nutr. 2001 Apr. 32 (4):471-4. [QxMD MEDLINE Link].
Sampson LK, Georgeson KE, Royal SA. Laparoscopic gastric antroplasty in children with delayed gastric emptying and gastroesophageal reflux. J Pediatr Surg. 1998 Feb. 33 (2):282-5. [QxMD MEDLINE Link].
Smith CD, Othersen HB Jr, Gogan NJ, Walker JD. Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals. Ann Surg. 1992 Jun. 215 (6):654-8; discussion 658-9. [QxMD MEDLINE Link].
Knight CG, Lorincz A, Gidell KM, Lelli J, Klein MD, Langenburg SE. Computer-assisted robot-enhanced laparoscopic fundoplication in children. J Pediatr Surg. 2004 Jun. 39 (6):864-6; discussion 864-6. [QxMD MEDLINE Link].
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. 2006 Aug. 41 (8):1392-6. [QxMD MEDLINE Link].
Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Wolfe MM, 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. 2002 Feb. 55 (2):149-56. [QxMD MEDLINE Link].
Richards WO, Houston HL, Torquati A, Khaitan L, Holzman MD, Sharp KW. Paradigm shift in the management of gastroesophageal reflux disease. Ann Surg. 2003 May. 237 (5):638-47; discussion 648-9. [QxMD MEDLINE Link].
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. 2004 Mar. 39 (3):282-6; discussion 282-6. [QxMD MEDLINE Link].
Mahmood Z, McMahon BP, Arfin Q, Byrne PJ, Reynolds JV, Murphy EM, et al. Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up. Gut. 2003 Jan. 52 (1):34-9. [QxMD MEDLINE Link]. [Full Text].
Strople J, Kaul A. Pediatric gastroesophageal reflux disease--current perspectives. Curr Opin Otolaryngol Head Neck Surg. 2003 Dec. 11 (6):447-51. [QxMD MEDLINE Link].
Thomson M, Fritscher-Ravens A, Hall S, Afzal N, Ashwood P, Swain CP. Endoluminal gastroplication in children with significant gastro-oesophageal reflux disease. Gut. 2004 Dec. 53 (12):1745-50. [QxMD MEDLINE Link]. [Full Text].
Lee SL, Sydorak RM, Chiu VY, Hsu JW, Applebaum H, Haigh PI. Long-term antireflux medication use following pediatric Nissen fundoplication. Arch Surg. 2008 Sep. 143 (9):873-6; discussion 876. [QxMD MEDLINE Link].
Richards CA. Does retching matter? Reviewing the evidence-Physiology and forces. J Pediatr Surg. 2019 Apr. 54 (4):750-759. [QxMD MEDLINE Link].
Ravelli AM, Milla PJ. Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr. 1998 Jan. 26 (1):56-63. [QxMD MEDLINE Link].
Richards CA, Andrews PL, Spitz L, Milla PJ. Nissen fundoplication may induce gastric myoelectrical disturbance in children. J Pediatr Surg. 1998 Dec. 33 (12):1801-5. [QxMD MEDLINE Link].
Tanaka Y, Tainaka T, Uchida H. Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease. Surg Today. 2018 Nov. 48 (11):971-977. [QxMD MEDLINE Link].

Media Gallery

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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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, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

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

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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 Association for Physician Leadership, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Association for Surgical Education

Disclosure: Nothing to disclose.

Chief Editor

Robert K Minkes, MD, PhD, MS Professor of Anatomy and Surgery, Founding Faculty, Orlando College of Osteopathic Medicine

Robert K Minkes, MD, PhD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

YiMing Avery Ching, MD Research Fellow, Department of Pediatric Surgery, Children’s Hospital of Boston