Treatment to control gastroesophageal reflux disease in children found to be ineffective

According to a study published in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology, more than 60 percent of the children who received surgical fundoplication to control gastroesophageal reflux disease (GERD) had recurring symptoms of the disease months following surgery.

The procedure is the third most common major surgical procedure performed in children. Overall, fundoplication as a treatment for GERD in children needs further evaluation.

Results of this retrospective cohort study, conducted on 198 children who underwent fundoplication at Texas Children's Hospital in Houston from 1996-1999, suggest that fundoplication for the treatment of GERD in children is not the most effective method of short- or long-term treatment for the disease. GERD in young children is often overlooked and is normally outgrown by the time a child reaches their first birthday. However, GERD that develops in older children can be very severe and persistent.

"Fundoplication is not a long-term solution for children with GERD, whether or not they have medical conditions that predispose them to the disease," said Hashem El-Serag, MD, MPH, senior study author. "This study emphasizes the importance of pre-operative counseling on alternative treatment options for GERD in children, as well as an assessment of the risks and benefits involved."

Fundoplication is a procedure which involves surgical strengthening of the sphincter between the esophagus and the stomach. This can reduce the amount of stomach acid that backs up into the esophagus, which can cause repeated vomiting, coughing and other respiratory problems in children.

Currently, there are a number of medical alternatives for GERD, including therapy with histamine-2 receptor antagonists (HRAs), proton pump inhibitors (PPIs) and prokinetics. There are several brands of each of these therapies available by prescription and over-the-counter; however, most of these therapies only provide short-term relief of symptoms. Although endoscopy is another method which provides a simpler way of treating GERD in adults, its long-lasting efficacy has not been determined. Researchers advise patients to discuss alternatives to fundoplication prior to surgery.

Lead study author Mark A. Gilger, MD and other researchers at Baylor College of Medicine conducted a retrospective cohort study using the medical records of all children who underwent fundoplication during 1996 and 1999 at Texas Children's Hospital in Houston, TX. There were two groups of children in the study, those who had one or more associated medical conditions (e.g., cystic fibrosis, reactive airway disease) and those who had no pre-existing diseases that increased their risk of developing GERD. Moreover, children with associated medical disorders had an increased incidence of lung infections and dumping syndrome. Findings from this single-center study need to be confirmed in future prospective studies to determine generalizability.

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