Open AccessGastro‐esophageal Reflux After Laparoscopic Gastrostomy Placement in Children
Author(s) -
Franken Josephine,
Stellato Rebecca K.,
Tytgat Stefaan H.A.J.,
Van der Zee David C.,
Mauritz Femke A.,
Lindeboom Maud Y.A.
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002530
Subject(s) - medicine , reflux , gastrostomy , pathological , enteral administration , gerd , esophageal ph monitoring , prospective cohort study , gastroenterology , surgery , parenteral nutrition , disease
Objectives: Gastrostomy placement is frequently performed in pediatric patients who require long‐term enteral tube feeding. Evidence on the influence of gastrostomy placement on gastro‐oesophageal reflux disease has been inconsistent. The aim of this study was to investigate the influence of gastrostomy on gastro‐oesophageal reflux. Methods: A prospective, longitudinal cohort study was performed including 50 patients who underwent laparoscopic gastrostomy between May 2012 and April 2014. Before and 3 months after surgery 24‐hour multichannel intraluminal impedance pH monitoring was performed and caregivers filled out reflux symptom questionnaires. Results: Gastro‐oesophageal reflux symptoms were present in a comparable number of patients before (44%) and after gastrostomy placement (40%; P = 0.73). Twenty‐five of the patients (50%) underwent both the preoperative and postoperative tests and were included in impedance‐pH analysis. Acid exposure time (percentage of time with pH below 4) did not change significantly after gastrostomy placement: from 6.2% (3.0–18.1) to 6.1% (2.6–14.9). The number of reflux episodes did not significantly change, for either liquid [mean difference 4.3 (−4.5 to 13.2)] or mixed liquid‐gas reflux [mean difference 2.0 (−9.3 to 13.3)]. Before gastrostomy placement, 18 out of 25 patients had pathological reflux (72%) on pH‐impedance measurement. In 4 patients, pathological reflux dissolved, whereas 4 patients newly developed pathological reflux. A low preoperative weight‐for‐height percentile was associated with increased acid exposure after gastrostomy placement. Conclusions: Overall, gastrostomy placement was not associated with an increase in acid exposure on 24‐hour multichannel intraluminal impedance pH monitoring. Similarly, the prevalence of gastro‐oesophageal reflux‐related symptoms did not change after gastrostomy.