title: Improvement in reflux gastroesophagitis in a patient with spinal muscular atrophy after surgical correction of kyphoscoliosis: a case report.
abstract: BACKGROUND
  Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux.
  
  
  METHODS
  A 15-year-old girl with severe thoracolumbar kyphoscoliosis visited our scoliosis research institute complaining of back pain, positional imbalance, intermittent respiratory tract infections, and gastrointestinal discomfort such as pain, dysphagia, and heartburn for several years. On preoperative CT, her abdominal organs were in a deviant position, and esophagogastroduodenoscopy revealed severe reflux gastroesophagitis, Los Angeles classification (LA) Grade D, and a sliding hiatus hernia. After kyphoscoliosis correction, the patient's truncal balance and pain improved. Postoperatively, the patient reported abdominal pain and dysphagia that gradually subsided after 3 weeks. At 1 year, the patient had no abdominal complaints secondary to reflux gastroesophagitis, and episodes of recurrent respiratory tract infections were substantially reduced. Postoperative evaluation showed the reflux gastroesophagitis had improved to LA Grade A. Postoperative CT showed the abdominal cavity had expanded and the abdominal organs were more centered.
  
  
  METHODS
  The association between scoliosis and reflux gastroesophagitis is well documented. However, the secondary effects of scoliosis correction on gastrointestinal symptoms caused by reflux gastroesophagitis have not been investigated in detail.
  
  
  CONCLUSIONS
  This patient illustrates the relationship between spinal deformity and gastrointestinal symptoms. Postural balance correction resulted in the alleviation of reflux gastroesophagitis symptoms secondary to hiatus hernia.
authors.affiliation: Department of Orthopaedics, Scoliosis Research Institute, Korea University Guro Hospital, Guro dong gil 97, Guro-gu, Seoul, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Niraj Sharad
authors.initials: NS
authors.lastname: Kasat
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Suh
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D016145:Endoscopy, Digestive System; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004942:Esophagitis, Peptic / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D007738:Kyphosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae; D019637:Orthopedic Procedures; D011859:Radiography; D012600:Scoliosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D014897:Spinal Muscular Atrophies of Childhood / Q000150:complications*; D013904:Thoracic Vertebrae