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Young Infants with GERD Undergo Antireflux Surgery More Often Than Older Infants and Children

Summary and Comment |
November 13, 2013

Young Infants with GERD Undergo Antireflux Surgery More Often Than Older Infants and Children

  1. F. Bruder Stapleton, MD

Procedures were performed in 8% of hospitalized children with GERD, and more than half were aged <6 months.

  1. F. Bruder Stapleton, MD

Children with gastroesophageal reflux disease (GERD) are often diagnosed clinically, treated medically, and referred for surgical evaluation only after a 3- to 6-month trial of more-conservative therapy fails. To examine factors associated with surgical intervention, researchers conducted a retrospective cohort study of 141,190 children with GERD at 41 U.S. children's hospitals.

Antireflux procedures were performed in 8% of the cohort, and more than half (53%) of these children were age 6 months or younger. Children undergoing procedures were more likely to have Medicaid insurance, aspiration pneumonia, and failure to thrive than those who did not. Among many comorbidities associated with increased risk for undergoing a procedure, hiatal hernia, failure to thrive, and neurodevelopmental delay were the most common (hazards ratios, 4.69, 2.67, and 2.42, respectively). Upper gastrointestinal fluoroscopy was the most common preoperative diagnostic procedure (65%) and was most often performed in infants younger than 2 months. Each rehospitalization for GERD was associated with a 10% additional risk for undergoing an antireflux procedure.

Comment

This study suggests that patient age influences decisions to perform antireflux surgery in children. Ironically, the highest risk for surgery is when infants have the greatest frequency of physiological regurgitation. The study also indicates that the most accurate diagnostic tests for gastroesophageal reflux disease (e.g., esophageal pH studies) are often not used for preoperative evaluation. As with many other common diagnoses, we need more rigorous standardization of diagnosis and treatment of pediatric GERD.

  • Disclosures for F. Bruder Stapleton, MD at time of publication Consultant / advisory board Navigant Consulting Grant / research support NIH-NICHD; NIH-NCI Editorial boards UpToDate Leadership positions in professional societies American Board of Pediatrics (Chair, Subspecialties Committee); American Pediatric Society (Past President and Council Nominating Chair)

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