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Diagnosis and Management of Gastroesophageal Reflux Disease in Pediatric Patients

  • Gretchen Purcell JacksonEmail author
Chapter

Abstract

This chapter addresses the nuances of the diagnosis and surgical treatment of gastroesophageal reflux disease (GERD) in infants and children. Physiological gastroesophageal reflux (GER) is common in infants and must be carefully distinguished from the symptoms and complications of this entity which define GERD. Reflux seen in infancy and its symptoms often resolve after the first year of life. Thus, the severity of reflux manifestations and complications must be carefully considered when invasive therapies are contemplated in this age group. Presenting symptoms cannot accurately diagnose reflux disease or predict response to therapy in young children, but typical symptoms may be adequate for diagnosis in adolescents. Combined multiple intraluminal esophageal impedance and pH monitoring is the gold standard test for the diagnosis of GERD, correlation of reflux episodes with symptoms, and evaluation of response to therapy in the pediatric population. Surgical treatment is indicated for pediatric patients with chronic GER that is refractory to medical management or has associated life-threatening complications. Nissen fundoplications have lower failure rates than partial fundoplications, but a greater risk of dysphagia requiring intervention. Minimal esophageal dissection with preservation of the phrenoesophageal membrane significantly reduces the likelihood of wrap migration and reoperation after fundoplication in children.

Keywords

Gastroesophageal reflux Gastroesophageal reflux disease Infants Children Adolescents Nissen fundoplication Toupe fundoplication 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryMonroe Carell Jr. Children’s Hospital at VanderbiltNashvilleUSA

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