Pediatric Surgery International

, Volume 34, Issue 11, pp 1139–1149 | Cite as

Gastroesophageal reflux in children with neurological impairment: a systematic review and meta-analysis

  • Giuseppe LauritiEmail author
  • Gabriele Lisi
  • Pierluigi Lelli Chiesa
  • Augusto Zani
  • Agostino Pierro
Review Article


Neurologically impaired children (NIC) suffer severe gastroesophageal reflux (GER) with poor fundoplication outcome. Aims of the study were: (1) to determine the recurrence of GER after fundoplication in NIC; (2) to compare fundoplication versus gastro-jejunal tube feeding insertion (GJ) and fundoplication versus total esophagogastric dissociation (TEGD) in primarily treating GER in NIC. Using defined search strategy, two investigators identified all comparative studies reporting the mentioned procedures to primarily treat GER in NIC. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 3840 titles/abstracts screened, 14 studies on fundoplication (2716 pts.) reported a recurrence/persistence of GER higher in NIC (14.2 ± 8.3%) than in neurologically normal (9.4 ± 5.2%; p = 0.0001), with an increased incidence of re-do fundoplication (12.6 ± 7.0% versus 9.1 ± 4.5%; p < 0.01). Three studies revealed a similar risk of undergoing subsequent fundoplication after GJ (4.9 ± 2.1%) or initial fundoplication (12.0 ± 0.6%; p = ns). Four studies showed a lower recurrence of GER following TEGD (1.4 ± 1.1%) than fundoplication (24.8 ± 1.4%; p = 0.002). NIC are at risk of recurrence/persistence of GER after fundoplication or GJ. TEGD seems more effective to primarily treat GER in NIC. Prospective randomized controlled trials are necessary to establish which is the ideal treatment of GER in NIC.


Gastroesophageal reflux Neurologically impaired children Fundoplication Gastro-jejunal tube feeding Total esophagogastric dissociation Systematic review Meta-analysis 



This study was not funded by any grant.

Compliance with ethical standards

Conflict of interest

Authors have no potential conflicts of interest for this study.

Ethical approval

Not applicable, since the study is a systematic review and meta-analysis.

Informed consent

Not applicable, since the study is a systematic review and meta-analysis.

Supplementary material

383_2018_4335_MOESM1_ESM.doc (32 kb)
Supplementary material 1 (DOC 32 KB)
383_2018_4335_MOESM2_ESM.doc (274 kb)
Supplementary material 2 (DOC 273 KB)
383_2018_4335_MOESM3_ESM.doc (34 kb)
Supplementary material 3 (DOC 33 KB)
383_2018_4335_MOESM4_ESM.doc (57 kb)
Supplementary material 4 (DOC 57 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Pediatric Surgery“G. d’Annunzio” University and “Spirito Santo” HospitalChieti-PescaraItaly

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