Diagnosis and Management of Gastroesophageal Reflux Disease in Pediatric Patients
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.
KeywordsGastroesophageal reflux Gastroesophageal reflux disease Infants Children Adolescents Nissen fundoplication Toupe fundoplication
- 1.Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.CrossRefPubMedGoogle Scholar
- 23.Surgeons SSoAGaE. Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD) 2010. http://www.sages.org/publications/guidelines/guidelines-for-surgical-treatment-of-gastroesophageal-reflux-disease-gerd/.Google Scholar
- 25.St Peter SD, Valusek PA, Calkins CM, Shew SB, Ostlie DJ, Holcomb 3rd GW. Use of esophagocrural sutures and minimal esophageal dissection reduces the incidence of postoperative transmigration of laparoscopic Nissen fundoplication wrap. J Pediatr Surg. 2007;42(1):25–9; discussion 9–30.CrossRefPubMedGoogle Scholar
- 28.ClinicalTrials.Gov. Prospective Randomized Trial Evaluating the Utility of Esophageal Stitches During Laparoscopic Fundoplication 2015. https://clinicaltrials.gov/ct2/show/NCT01509352. Accessed 5 July 2015Google Scholar