title: Gastro-oesophageal reflux and feeding problems after gastrostomy in children with severe neurological impairment.
abstract: This study evaluated the effect of percutaneous endoscopic gastrostomy (PEG) on the feeding problems and gastro-oesophageal reflux (GOR) of 30 consecutive children with severe neurological impairment who had PEG between October 1990 and March 1993. Evaluation was by questionnaire, clinical history, examination, 24-hour oesophageal pH monitoring and endoscopy. Gastrostomy placement significantly reduced feeding time, feed-related choking episodes and frequency of chest infections. Family stress was significantly reduced in two-thirds of cases. Significant weight-gain occurred. The clinical severity of GOR was significantly increased in eight patients and fundoplication was required in five. 24-hour oesophageal pH measurements before PEG did not reliably predict subsequently increased GOR. Seven patients died, but their deaths were apparently unrelated to GOR. PEG effectively provides nutrition, improves feed-related stresses, but may exacerbate GOR.
authors.affiliation: Department of Gastroenterology, Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: R G
authors.initials: RG
authors.lastname: Heine
authors.forename: D S
authors.initials: DS
authors.lastname: Reddihough
authors.forename: A G
authors.initials: AG
authors.lastname: Catto-Smith
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D004941:Esophagitis / Q000150:complications / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000503:physiopathology*; D012720:Severity of Illness Index; D015430:Weight Gain