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Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study. CHILDREN-BASEL 2021; 8:children8010055. [PMID: 33477368 PMCID: PMC7830350 DOI: 10.3390/children8010055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. METHODS Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. RESULTS The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score -2.68 ± 0.8 vs -0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents' perceptions of the general health and emotional state of their babies (p < 0.001). CONCLUSIONS The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.
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Abstract
Recent guidelines focus on a non-interventionist approach to management of gastro-oesophageal reflux in infancy and emphasise the importance of explanation, reassurance and simple measures such as attention to feeding. Relying on clinical history alone leads to over diagnosis of disease, and widely used medications are often ineffective for symptom relief and carry significant risk of harm. The association between vomiting in infancy and other problems such as crying and poor feeding should not be interpreted as implying causality. When there are strong pointers to underlying gastro-oesophageal reflux disease, invasive investigations are required in order to formulate appropriate intervention.
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Ferreira CT, Carvalho ED, Sdepanian VL, Morais MBD, Vieira MC, Silva LR. Gastroesophageal reflux disease: exaggerations, evidence and clinical practice. J Pediatr (Rio J) 2014; 90:105-18. [PMID: 24184302 DOI: 10.1016/j.jped.2013.05.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/23/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. The association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children. DATA SOURCE a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013. DATA SYNTHESIS abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects. CONCLUSIONS there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.
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Affiliation(s)
- Cristina Targa Ferreira
- Pediatric Gastroenterology Service, Hospital da Criança Santo Antônio, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil; Pediatrics Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil.
| | - Elisa de Carvalho
- Pediatrics Unit, Hospital de Base do Distrito Federal, DF, Brazil; Hospital da Criança de Brasília, DF, Brazil; Centro Universitário de Brasília, DF, Brazil; Pediatric Gastroenterology Department, Sociedade Brasileira de Pediatria, Brasília, DF, Brazil
| | - Vera Lucia Sdepanian
- Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mauro Batista de Morais
- Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Clínica de Especialidades Pediátricas, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mário César Vieira
- Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; Pediatric Gastroenterology Service, Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Hospital da Criança de Brasília, DF, Brazil
| | - Luciana Rodrigues Silva
- Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Gastroenterology and Hepatology Service, Universidade Federal da Bahia, Salvador, BA, Brazil; Academia Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
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Gastroesophageal reflux disease: exaggerations, evidence and clinical practice. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2013.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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