1
|
Bongiovanni A, Parisi GF, Scuderi MG, Licari A, Brambilla I, Marseglia GL, Leonardi S. Gastroesophageal reflux and respiratory diseases: does a real link exist? Minerva Pediatr 2019; 71:515-523. [PMID: 31129955 DOI: 10.23736/s0026-4946.19.05531-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD. EVIDENCE ACQUISITION This review was conducted employing 2 databases: PubMed and Science Direct. EVIDENCE SYNTHESIS Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations. CONCLUSIONS The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.
Collapse
Affiliation(s)
- Annarita Bongiovanni
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe F Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Maria G Scuderi
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Gian L Marseglia
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
2
|
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; 28:1023-1028. [PMID: 29466083 DOI: 10.1089/lap.2017.0631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Respiratory manifestations of gastroesophageal reflux disease (GERD), particularly chronic cough, are being recognized with increased frequency in children. This survey aimed to investigate the efficacy of laparoscopic Nissen fundoplication for treatment of GERD-related respiratory symptoms not responsive to medical therapy in neurological normal children. MATERIALS AND METHODS We collected data of children with GERD-related respiratory complaints not responsive to medical therapy who underwent laparoscopic Nissen fundoplication in four European centers of Pediatric Surgery over a 10-year period. We excluded children with neurological impairment. RESULTS A total of 220 laparoscopic Nissen procedures were performed in the period 2005-2015. Twenty-four (12 boys and 12 girls, average age 9.5 years) out of the 220 patients (10.9%) presented with chronic cough and other respiratory manifestations, including asthma, reactive airway disease, and recurrent pneumonia. Average operative time was 65 minutes (range 45-100). As for postoperative complications, two tight wraps requiring endoscopic dilatation (IIIb Clavien) and two relapses of GERD for slipped Nissen requiring reoperation (IIIb Clavien) were recorded. None of these complications occurred in the group of patients with GERD-related respiratory symptoms. At follow-up evaluation, respiratory symptoms disappeared with a significant improvement of quality of life scoring (I Grade Visick) in 22/24 patients (91.6%). CONCLUSION Our results confirm that GERD should be investigated as one of the possible etiologic factors in any child with persistent respiratory complaints. In patients with symptoms not responsive to medical therapy, laparoscopic Nissen fundoplication is the treatment of choice with a very high success rate (>90% in our series), a very low morbidity, a significant improvement in airway symptoms, and a marked reduction in the need for medications.
Collapse
Affiliation(s)
- Ciro Esposito
- 1 Division of Pediatric Surgery, Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy
| | - Amulya Saxena
- 2 Division of Pediatric Surgery, Chelsea Children's Hospital , London, United Kingdom
| | - Sabine Irtan
- 3 Division of Pediatric Surgery, Hôpital Armand Trousseau , Paris, France
| | - Holger Till
- 4 Division of Pediatric Surgery, Medical University of Graz , Graz, Austria
| | - Maria Escolino
- 1 Division of Pediatric Surgery, Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy
| |
Collapse
|
3
|
Jancelewicz T, Lopez ME, Downard CD, Islam S, Baird R, Rangel SJ, Williams RF, Arnold MA, Lal D, Renaud E, Grabowski J, Dasgupta R, Austin M, Shelton J, Cameron D, Goldin AB. Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review. J Pediatr Surg 2017; 52:1228-1238. [PMID: 27823773 DOI: 10.1016/j.jpedsurg.2016.09.072] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/20/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the surgical treatment of pediatric gastroesophageal reflux disease (GERD). METHODS Five questions were addressed by searching the MEDLINE, Cochrane, Embase, Central, and National Guideline Clearinghouse databases using relevant search terms. Consensus recommendations were derived for each question based on the best available evidence. RESULTS There was insufficient evidence to formulate recommendations for all questions. Fundoplication does not affect the rate of hospitalization for aspiration pneumonia, apnea, or reflux-related symptoms. Fundoplication is effective in reducing all parameters of esophageal acid exposure without altering esophageal motility. Laparoscopic fundoplication may be comparable to open fundoplication with regard to short-term clinical outcomes. Partial fundoplication and complete fundoplication are comparable in effectiveness for subjective control of GERD. Fundoplication may benefit GERD patients with asthma, but may not improve outcomes in patients with neurologic impairment or esophageal atresia. Overall GERD recurrence rates are likely below 20%. CONCLUSIONS High-quality evidence is lacking regarding the surgical management of GERD in the pediatric population. Definitive conclusions regarding the effectiveness of fundoplication are limited by patient heterogeneity and lack of a standardized outcomes reporting framework. TYPE OF STUDY Systematic review of level 1-4 studies. LEVEL OF EVIDENCE Level 1-4 (mainly level 3-4).
Collapse
Affiliation(s)
- Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105.
| | - Monica E Lopez
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, Program Director, Pediatric Surgery Fellowship, University of Louisville, Louisville, KY
| | | | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC
| | - Shawn J Rangel
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105
| | - Meghan A Arnold
- CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Dave Lal
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth Renaud
- Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY
| | - Julia Grabowski
- Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Mary Austin
- Department of Pediatric Surgery, The University of Texas Medical School at Houston and in Surgical Oncology and Pediatrics at the UT M.D., Anderson Cancer Center, Houston, TX
| | - Julia Shelton
- Division of Pediatric Surgery, University of Iowa Children's Hospital, Iowa City, IA
| | - Danielle Cameron
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
4
|
Esposito C, Roberti A, Turrà F, Escolino M, Cerulo M, Settimi A, Farina A, Vecchio P, Di Mezza A. Management of gastroesophageal reflux disease in pediatric patients: a literature review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2015; 6:1-8. [PMID: 29388573 PMCID: PMC5683257 DOI: 10.2147/phmt.s46250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is a physiologic process that occurs throughout the day in healthy infants and children. Gastroesophageal reflux disease (GERD) occurs when gastric contents flow back into the esophagus and produce symptoms. The most common esophageal symptoms are vomiting and regurgitation. Lifestyle changes are the first-line therapy in both GER and GERD; medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. The laparoscopic Nissen antireflux procedure is the gold standard for the treatment of this pathology. A literature search on PubMed and Cochrane Database was conducted with regard to the management of GERD in children to provide a view of state-of-the-art treatment of GERD in pediatrics.
Collapse
Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Agnese Roberti
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Francesco Turrà
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Alessandra Farina
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Pietro Vecchio
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Antonio Di Mezza
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| |
Collapse
|
5
|
Long-term effects of fundoplication in children with chronic airway diseases. J Pediatr Surg 2015; 50:206-10. [PMID: 25598124 DOI: 10.1016/j.jpedsurg.2014.09.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Association between chronic airway diseases (CAD) and gastroesophageal reflux disease (GERD) is well described, but causality has not yet been conclusively established. This study evaluates the therapeutic significance of laparoscopic Thal fundoplication in children with CAD and diagnosed GERD. METHODS We performed a retrospective analysis of 182 neurologically nonimpaired children, all with medically refractory CAD and GERD undergoing laparoscopic Thal fundoplication. The clinical response, ability to wean oral and inhaled medication and satisfaction with postoperative results were evaluated. RESULTS Main symptoms disappeared completely in 68.7% of patients and were markedly improved in a further 22% of patients following surgery. Complete discontinuation of medication was achieved in 70.1-96.4% of cases and reduced in a further 1.8-23.5%. One intraoperative complication occurred (gastric perforation), however no conversion to laparotomy was necessary. Postoperative Dumping Syndrome occurred in 1% of cases and was managed dietetically. Prolonged postoperative dysphagia occurred in 4.3% of patients, but disappeared within 8 weeks in all but one case. CONCLUSIONS Our study suggests that Thal fundoplication in neurologically nonimpaired children with CAD and documented GERD is effective and safe. Children unresponsive to preoperative medical management showed significant improvement in airway symptoms together with a marked reduction in the need for medication. We conclude that laparoscopic Thal fundoplication represents a significant treatment worthy of consideration in this group of patients.
Collapse
|
6
|
Outcomes of pediatric laparoscopic fundoplication: a critical review of the literature. Can J Gastroenterol Hepatol 2014; 28:97-102. [PMID: 24288692 PMCID: PMC4071886 DOI: 10.1155/2014/738203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVE Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) is one of the most common procedures performed in children. A critical literature review was performed to evaluate the level and quality of evidence supporting the efficacy of this procedure. METHODS Systematic reviews of the EMBASE, PubMed and CENTRAL databases were conducted to retrieve all articles published over a 15-year period (1996 to 2010) reporting medium- to long-term outcomes (minimum six months follow-up) of laparoscopic fundoplication for the treatment of pediatric GERD. Articles were critically appraised using the Newcastle-Ottawa quality assessment scale and the Cochrane risk of bias assessment tool. Extracted outcomes included GERD recurrence, need for reoperation, postoperative morbidity and mortality. RESULTS A total of 5302 articles were retrieved. Thirty-six studies met inclusion and exclusion criteria, including five prospective (level 2b), four retrospective comparative (level 3b) and 27 case series (level 4). No studies compared laparoscopic fundoplication with medical treatment. Thirty-six per cent of studies did not describe the symptoms used to suspect GERD; 11% did not disclose the diagnostic modalities used; and 41% did not report the findings of diagnostic modalities. Only 17% of studies provided a definition of recurrence, and only 14% attempted to control for confounding variables. The follow-up intervals were inconsistently reported, ranging between two months and nine years. Significant heterogeneity among studies limited the ability to pool outcomes. Mean (± SD) recurrence rates varied between 0% and 48±19.6% of patients. Reoperation was required in 0.69±0.95% to 17.7±8.4% of patients. Mortality ranged between 0% and 24±16.7%. CONCLUSION The level and quality of the evidence supporting laparoscopic fundoplication are extremely poor. Higher-quality data are required before the procedure can be considered to be an effective intervention in the treatment of pediatric GERD.
Collapse
|
7
|
Sacco O, Mattioli G, Girosi D, Battistini E, Jasonni V, Rossi GA. Gastroesophageal reflux and its clinical manifestation at gastroenteric and respiratory levels in childhood: physiology, signs and symptoms, diagnosis and treatment. Expert Rev Respir Med 2014; 1:391-401. [DOI: 10.1586/17476348.1.3.391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Oliviero Sacco
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Girolamo Mattioli
- Division and Chair of Pediatric Surgery, Largo Gaslini 5, 16147 Genoa, Italy
| | - Donata Girosi
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Elena Battistini
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Vincenzo Jasonni
- Division and Chair of Pediatric Surgery, Largo Gaslini 5, 16147 Genoa, Italy
| | - Giovanni A Rossi
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| |
Collapse
|
8
|
Jackson HT, Kane TD. Surgical management of pediatric gastroesophageal reflux disease. Gastroenterol Res Pract 2013; 2013:863527. [PMID: 23762041 PMCID: PMC3665246 DOI: 10.1155/2013/863527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/11/2013] [Accepted: 03/27/2013] [Indexed: 01/15/2023] Open
Abstract
Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients.
Collapse
Affiliation(s)
- Hope T. Jackson
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Timothy D. Kane
- Division of Pediatric Surgery, Department of Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
- Surgical Residency Training Program, Children's National Medical Center, Division of Pediatric Surgery, 111 Michigan Avenue, NW Washington, DC 20010-2970, USA
| |
Collapse
|
9
|
Fike FB, Pettiford JN, St Peter SD, Cocjin J, Laituri CA, Ostlie DJ. Utility of pH/multichannel intraluminal impedance probe in identifying operative patients in infants with gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A 2012; 22:518-20. [PMID: 22568542 DOI: 10.1089/lap.2011.0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Gastroesophageal reflux is a common clinical problem in infants, but identifying which infants may benefit from a fundoplication remains a conundrum. Esophageal pH and multichannel intraluminal impedance (MII) measurements are useful diagnostic tools in adults and older children, but their diagnostic efficacy in infants is unclear. Therefore, we reviewed our experience with the combined pH/MII probe in this population. SUBJECTS AND METHODS A retrospective review of patients ≤ 6 months of age who were studied with the pH/MII probe from 2006 to 2010 was performed. Test results, interventions, and outcomes were reviewed. Patients were divided into operative and nonoperative groups, and pH probe and MII results were compared. RESULTS Fifty-seven patients (53% male) were identified. Mean age at the time of pH/MII probe was 3.1 months. Regarding the operative group (n = 33), 21% had an abnormal pH probe, and 100% had an abnormal MII; 97% had symptom improvement at a mean follow-up of 16 months (range, 0.4-38 months). In the nonoperative group (n = 24), 29% had an abnormal pH probe, and 100% had an abnormal MII. There was no significant difference in reflux index, Boix-Ochoa score, or percentage of acid and non-acid reflux between the two groups. CONCLUSIONS The pH and MII studies are poor indicators of pathologic reflux in infants and do not adequately discern which patients will benefit from fundoplication.
Collapse
Affiliation(s)
- Frankie B Fike
- The Children's Mercy Hospital, Kansas City, Missouri, 64108, USA
| | | | | | | | | | | |
Collapse
|
10
|
Esposito C, De Luca C, Alicchio F, Giurin I, Miele E, Staiano AM, Settimi A. Long-term outcome of laparoscopic Nissen procedure in pediatric patients with gastroesophageal reflux disease measured using the modified QPSG Roma III European Society for Pediatric Gastroenterology Hepatology and Nutrition's questionnaire. J Laparoendosc Adv Surg Tech A 2011; 22:937-40. [PMID: 22047187 DOI: 10.1089/lap.2011.0254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND/PURPOSE Laparoscopic fundoplication (LF) represents the gold standard for surgical treatment for pediatric patients with gastroesophageal reflux disease (GERD). METHODS We report the results of long-term outcome of 36 patients who had undergone LF from January to December 1998, with a follow-up longer than 10 years (range, 11-12 years). The patients were invited, by phone, to undergo a clinical follow-up. All patients underwent the modified European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)'s Roma III questionnaire; however, only 22 out of 36 patients accepted to be controlled in a day hospital setting, and 10 out of 36 accepted to undergo a telephonic questionnaire. Our study is focused on the data of these 32 patients. RESULTS Twenty-eight out of 32 (87.5%) patients had completely recovered; 4 out of 32 patients (12.5%) had a mild persistent GER; 9 out of 32 patients (28%) referred a mild dysphagia; 21 out of 32 (66%) patients could burp; and only 9 out of 32 (28%) patients could vomit. The cosmetic result was good in 30 out of 32 (94%) patients. The weight/height ratio was satisfactory in 28 out of 32 (87.5%) patients. The quality of life was good in 28 out of 32 (87.5%) patients. CONCLUSIONS Our experience shows that the long-term follow-up after LF produces a good clinical result and a good quality of life. The modified ESPGHAN's Roma III questionnaire seems an effective way to check the long-term results, because it avoids submitting patients to long and not well tolerated instrumental exams.
Collapse
Affiliation(s)
- Ciro Esposito
- Department of Pediatrics, Federico II University of Naples, Naples, Italy.
| | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Gastroesophageal reflux is commonly encountered in the infant population. Most children will outgrow their reflux but some develop pervasive disease and require medical or surgical treatment. Many tools exist for use in the workup of pediatric gastroesophageal reflux disease; however, the most effective method of diagnosis is not clear. Delineating which patients will benefit from more definitive therapy is a remarkable challenge in this group, often borrowing tools and principles from the adult patient population. Therefore, we reviewed the available literature to critically evaluate the merits and limitations of the current diagnostic modalities available for the evaluation of infantile gastroesophageal reflux.
Collapse
|
12
|
Abstract
BACKGROUND Because of complications and its invasive nature, fundoplication is often a treatment of last resort for children with gastroesophageal reflux. Gastroesophageal reflux testing does not always predict who will benefit from antireflux surgery. Furthermore, there are no studies to determine whether a higher preoperative reflux burden, including acid and nonacid reflux, is associated with an improved postfundoplication outcome. The aim of the study was to determine predictors of fundoplication outcome including acid and nonacid reflux burden. PATIENTS AND METHODS We retrospectively reviewed preoperative pH-multichannel intraluminal impedance tracings and medical records of 34 patients who underwent fundoplication. Patients were categorized as improved or not improved, and the demographic and reflux characteristics were compared between groups. Multivariate analysis was performed to determine predictors of outcome. RESULTS No single reflux marker, including the number of acid, nonacid, total events, or the percentage of time that reflux was in the esophagus, predicted fundoplication outcome (P > 0.1). Neither a positive symptom index nor a positive symptom sensitivity index predicted postoperative improvement (P > 0.4). Receiver operating characteristic curve analysis failed to reveal an ideal value to maximize sensitivity for either the symptom index or the symptom sensitivity index. CONCLUSIONS pH-multichannel intraluminal impedance testing may not be a useful tool in predicting fundoplication outcome.
Collapse
|
13
|
|
14
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:x-xiii. [PMID: 19371153 DOI: 10.1089/lap.2009.9982.supp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Mattioli G, Buffa P, Gandullia P, Schiaffino MC, Avanzini S, Rapuzzi G, Prato AP, Guida E, Costanzo S, Rossi V, Basile A, Montobbio G, DellaRocca M, Mameli L, Disma N, Pessagno A, Tomà P, Jasonni V. Laparoscopic Proximal Roux-en-Y Gastrojejunal Diversion in Children: Preliminary Experience from a Single Center. J Laparoendosc Adv Surg Tech A 2009; 19:807-13. [DOI: 10.1089/lap.2008.0291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Girolamo Mattioli
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Piero Buffa
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Paolo Gandullia
- Department of Gastroenterology, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | | | - Stefano Avanzini
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Giovanni Rapuzzi
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Alessio Pini Prato
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Sara Costanzo
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Valentina Rossi
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Angelina Basile
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Giovanni Montobbio
- Department of Anesthesia and Intensive Care, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Mirta DellaRocca
- Department of Anesthesia and Intensive Care, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Leila Mameli
- Department of Anesthesia and Intensive Care, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Nicola Disma
- Department of Anesthesia and Intensive Care, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Alice Pessagno
- Department of Neurology, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Paolo Tomà
- Department of Radiology, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| | - Vincenzo Jasonni
- Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy
| |
Collapse
|
16
|
Kane TD, Brown MF, Chen MK. Position paper on laparoscopic antireflux operations in infants and children for gastroesophageal reflux disease. American Pediatric Surgery Association. J Pediatr Surg 2009; 44:1034-40. [PMID: 19433194 DOI: 10.1016/j.jpedsurg.2009.01.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 01/23/2009] [Indexed: 12/18/2022]
Abstract
The use of the laparoscopic approach to perform antireflux procedures has increased dramatically since its introduction in 1991. To date, no prospective randomized studies comparing open surgery to the minimal invasive approach in children have been reported. Many retrospective reviews and case series have demonstrated that laparoscopic antireflux procedures are safe and effective once the learning curve is achieved. This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize the available evidence to identify the risks and benefits of laparoscopic antireflux procedures.
Collapse
Affiliation(s)
- Timothy D Kane
- Minimally Invasive Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | |
Collapse
|
17
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 19:x-xiii. [PMID: 19226225 DOI: 10.1089/lap.2009.9998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
-
- International Pediatric Endosurgery Group (IPEG), Los Angeles, CA 90064, USA.
| |
Collapse
|
18
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 18:x-xiii. [PMID: 19105663 DOI: 10.1089/lap.2008.9988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
19
|
Gurski RR, da Rosa ARP, do Valle E, de Borba MA, Valiati AA. Extraesophageal manifestations of gastroesophageal reflux disease. J Bras Pneumol 2007; 32:150-60. [PMID: 17273585 DOI: 10.1590/s1806-37132006000200011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 07/07/2005] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.
Collapse
|
20
|
Kawahara H, Okuyama H, Kubota A, Oue T, Tazuke Y, Yagi M, Okada A. Can laparoscopic antireflux surgery improve the quality of life in children with neurologic and neuromuscular handicaps? J Pediatr Surg 2004; 39:1761-4. [PMID: 15616922 DOI: 10.1016/j.jpedsurg.2004.08.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Children with neurologic and neuromuscular handicaps frequently have various symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. METHODS Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), and gastrostomy was performed concurrently in 52. The main symptoms were emesis/hematemesis in 40 and respiratory symptoms, including repeated respiratory infection and distress, in 31. RESULTS There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those without recurrence. Respiratory symptoms were controlled unsuccessfully in 16 patients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease occurred in 10 patients, 7 of whom underwent a second Nissen fundoplication successfully. Thirteen died within the median follow-up period of 14 months. CONCLUSIONS Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped children. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.
Collapse
Affiliation(s)
- Hisayoshi Kawahara
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|