title: The relationship between percutaneous endoscopic gastrostomy and gastro-oesophageal reflux disease in children: a systematic review.
abstract: BACKGROUND
  The relationship between percutaneous endoscopic gastrostomy (PEG) insertion and gastro-oesophageal reflux disease (GERD) is widely disputed in the current literature. The aim of this systematic review is to examine the available evidence documenting the association between PEG and GERD.
  
  
  METHODS
  The following databases were searched: MEDLINE (1950 to week 2, January 2011), PubMed, ISI Web of Knowledge (1898 to week 2, January, 2011), EMBASE (1980 to week 2, January 2011) and The Cochrane Central Register of Controlled Trials (CENTRAL) using the terms "gastroesophageal reflux", "gastroesophageal disease", "GERD", "GERD", "GER", "GER" and "percutaneous endoscopic gastrostomy", "PEG", "gastrostomy". In addition, the reference lists of all included studies were reviewed for relevant citations. Studies examining children pre and post insertion of PEG for GERD and written in English language were included. Data extraction was performed by two authors, and the methodology and statistical analysis of each study were assessed.
  
  
  RESULTS
  Eight studies were included in this systematic review. Two reported increased incidence of GERD after PEG. However, neither was of high methodological quality. The remaining six reported no change or decreased GERD. Nonetheless, few demonstrated rigorous methodology.
  
  
  CONCLUSIONS
  The current evidence examining the effect of PEG insertion on GERD has been inconsistent and is not of high quality and therefore is unconvincing, preventing a definitive conclusion. Overall, the available literature on this topic does not demonstrate a causal effect of PEG insertion on GERD.
authors.affiliation: Division of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors.forename: Louise J
authors.initials: LJ
authors.lastname: Noble
authors.forename: A Mark
authors.initials: AM
authors.lastname: Dalzell
authors.forename: Wael
authors.initials: W
authors.lastname: El-Matary
mesh_terms: D002648:Child; D005764:Gastroesophageal Reflux / Q000209:etiology*; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans