Gastroesophageal reflux after repair of congenital diaphragmatic hernia.
OBJECTIVE
Mechanisms of postoperative gastroesophageal reflux (GER) remain unclarified in congenital diaphragmatic hernia (CDH). The aim of this study was to examine clinical features of CDH contributing to GER.


METHODS
GER was evaluated as esophageal acid exposure measured with 24-hour pH monitoring at the average age of 1.7 +/- 0.9 months in 26 survivors of CDH. Correlations between the percentage total time pH below 4.0 (reflux index: RI)/number of long acid reflux (long reflux) and clinical features were investigated. The subjects were divided into 2 groups; group A: RI < or = 4.0% (n = 7) and group B: R greater than 4.0% (n = 19). Clinical features were compared between the 2 groups.


RESULTS
No significant correlation was noted between RI/long reflux and birth weight, preoperative AaDO2, duration of artificial ventilation, and dimension of the defect. The incidence of direct closure was significantly higher, but use of nitric oxide inhalation and a presence of intrathoracic liver lobe herniation were significantly lower in group B. There was no significant difference of other clinical features indicating the severity of CDH between the 2 groups.


CONCLUSIONS
An association of GER is not rare in early infancy after repair of CDH, which is influenced by the repair methods.
Kamiyama
Masafumi
M
Division of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
Kawahara
Hisayoshi
H
Okuyama
Hiroomi
H
Oue
Takaharu
T
Kuroda
Seika
S
Kubota
Akio
A
Okada
Akira
A
D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011300:Preoperative Care