title: Necessity for surgery in children with gastrooesophageal reflux and supraoesophageal symptoms.
abstract: OBJECTIVE
  The majority of gastrooesophageal reflux (GER) manifestations in children are supraoesophageal, and "spitting/posseting" is "the tip of the iceberg" because most reflux episodes are not regurgitated. Aim of the present study was to prospectively evaluate the incidence of gastrooesophageal reflux and the incidence of antireflux surgery in patients with difficult-to-treat respiratory symptoms.
  
  
  METHODS
  Five hundred and ninety-five children with difficult-to-treat respiratory symptoms were prospectively enrolled in a blind study looking for the correlation between clinical presentation (asthma or non-asthma), oesophageal pH monitoring, X-ray barium meal, broncho-alveolar lavage, necessity for surgery, and outcome.
  
  
  RESULTS
  pH monitoring was anomalous in 47% of patients with asthma (group A) and in 43% of those who did not have asthma as main symptom (group B). Overall, 48 patients finally underwent anti-reflux surgery (8%) as anti-reflux medical treatment did not ensure stable benefits. No major surgical complications were experienced. Postoperatively, respiratory symptoms improved strongly (Visick 1) in 69% of cases, moderately (Visick 2) in 27%, while clinical worsening (Visick 4) was observed in 4%.
  
  
  CONCLUSIONS
  The results of this study stress the importance of symptoms, clinical response to anti-reflux medical treatment and broncho-alveolar lavage compared to classical pH parameters in the decision-making process for patients with difficult-to-treat supraoesophageal symptoms. To date no single tool alone has proved to be diagnostic in these patients. Fundoplication is recommended only when a relationship between supraoesophageal symptoms and gastrooesophageal reflux is strongly suspected.
authors.affiliation: Paediatric Surgery Unit, Giannina Gaslini Research Institute, University of Genova, Italy. girolamomattioli@ospedale-gaslini.ge.it
authors.forename: G
authors.initials: G
authors.lastname: Mattioli
authors.forename: O
authors.initials: O
authors.lastname: Sacco
authors.forename: P
authors.initials: P
authors.lastname: Repetto
authors.forename: A
authors.initials: A
authors.lastname: Pini Prato
authors.forename: M
authors.initials: M
authors.lastname: Castagnetti
authors.forename: C
authors.initials: C
authors.lastname: Carlini
authors.forename: M
authors.initials: M
authors.lastname: Torre
authors.forename: S
authors.initials: S
authors.lastname: Leggio
authors.forename: V
authors.initials: V
authors.lastname: Gentilino
authors.forename: F
authors.initials: F
authors.lastname: Martino
authors.forename: B
authors.initials: B
authors.lastname: Fregonese
authors.forename: A
authors.initials: A
authors.lastname: Barabino
authors.forename: P
authors.initials: P
authors.lastname: Gandullia
authors.forename: G A
authors.initials: GA
authors.lastname: Rossi
authors.forename: V
authors.initials: V
authors.lastname: Jasonni
mesh_terms: D001249:Asthma / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008297:Male; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000209:etiology