Should fundoplication be added at the time of gastrostomy placement in patients who are neurologically impaired?
OBJECTIVE
Patients who have advanced neurologic impairment (NI) and require gastrostomy placement (GP) frequently have symptomatic gastroesophageal reflux. We investigated the outcomes of GP without fundoplication in patients who had NI.


METHODS
This was a retrospective review of 54 patients with NI (median, 7 years; range, 1-18 years) undergoing GP alone. The operative criteria included medically controllable or no reflux symptoms. The patients were divided into 2 groups based on the percentage of total esophageal time with a pH less than 4.0 (reflux index, or RI): group I (GI, n = 33), RI less than 5.0% (median age, 6 years; range, 2-15 years); group II (GII, n = 21), RI 5.0% or greater (median age, 10 years; range, 1-18 years). Data are expressed as medians and ranges.


RESULTS
Nutritional management was successfully conducted after GP with or without the administration of lansoprazole, famotidine, or rikkunshito in all but 2 patients. One GI patient with alpha-thalassemia required fundoplication, and one GII patient with Cockayne syndrome required gastrojejunal tube feeding. The RI increased significantly in GI patients (2.1% [0%-4.8%] vs 4.5% [0.2%-11.4%], P = .004), whereas it decreased significantly in GII patients (11.2% [5.9%-41.6%] vs 9.8% [1.05-26.6%], P = .04).


CONCLUSIONS
Gastroesophageal reflux and related symptoms rarely deteriorate to require additional treatment after GP in patients with NI. Gastrostomy placement is a less invasive and effective procedure for improving the quality of life in those patients.
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho Izumi, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
Hisayoshi
H
Kawahara
Yasuyuki
Y
Mitani
Keisuke
K
Nose
Hiroshi
H
Nakai
Akihiro
A
Yoneda
Akio
A
Kubota
Masahiro
M
Fukuzawa
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use; D004750:Enteral Nutrition; D015738:Famotidine / Q000627:therapeutic use; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D009422:Nervous System Diseases / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D019564:Unnecessary Procedures
D000897:Anti-Ulcer Agents; D004365:Drugs, Chinese Herbal; C084136:liu-jun-zi-tang; D015738:Famotidine