title: Risk factors for recurrent gastroesophageal reflux disease after fundoplication in pediatric patients: a case-control study.
abstract: OBJECTIVE
  Recurrent gastroesophageal reflux disease (rGERD) is a common problem after fundoplication. Previous studies attempting to identify risk factors for rGERD have failed to control for confounding variables. The purpose of this study was to identify significant risk factors for rGERD after controlling for potential confounding variables.
  
  
  METHODS
  A retrospective, matched case-control study was conducted at a tertiary children's hospital. Cases (n = 116) met 1 of these criteria: reoperation for rGERD, symptomatic rGERD (confirmed by upper gastrointestinal series, esophagogastroduodenoscopy, or pH monitoring), or postoperative reinstitution of antireflux medication for more than 8 weeks. Controls (n = 209) were matched for surgeon, approach (laparoscopic/open), technique (partial/complete), and approximate operative date. Univariate and multivariable associations were analyzed by conditional logistic regression.
  
  
  RESULTS
  Significant risk factors for rGERD were age of less than 6 years (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.5), preoperative hiatal hernia (OR, 3.2; 95% CI, 1.4-7.3), postoperative retching (OR, 5.1; 95% CI, 2.6-10.0), and postoperative esophageal dilatation (OR, 10.8; 95% CI, 1.8-65.4). Interestingly, significant association was not found between neurologic impairment and rGERD after controlling for potential confounding variables.
  
  
  CONCLUSIONS
  Age of less than 6 years, preoperative hiatal hernia, postoperative retching, and postoperative esophageal dilatation are independently associated with increased risk of rGERD. Neurologic impairment alone does not increase the risk of developing rGERD.
authors.affiliation: Department of Epidemiology and International Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Monawat
authors.initials: M
authors.lastname: Ngerncham
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: Ramanath N
authors.initials: RN
authors.lastname: Haricharan
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Roseman
authors.forename: Keith E
authors.initials: KE
authors.lastname: Georgeson
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
mesh_terms: D000367:Age Factors; D002648:Child; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006551:Hernia, Hiatal; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012307:Risk Factors