title: Impact of laparoscopic antireflux surgery on belching in pediatric GERD patients.
abstract: BACKGROUND
  Laparoscopic antireflux surgery (LARS) is a well-established treatment option for children with proton pomp inhibitor (PPI)-resistant gastroesophageal reflux disease (GERD). Besides preventing reflux of gastric fluid and solid content, LARS may also impair the ability of the stomach to vent intragastric air (i.e. gastric belching) and induce gas-related complications, such as bloating and/or hyperflatulence. Furthermore, it was previously hypothesized that LARS induces a behavioral type of belching, not originating from the stomach, called supragastric belching. The aim of this study was to objectively evaluate the impact of LARS on gastric (GB) and supragastric belching (SGB) in children with GERD.
  
  
  METHODS
  We performed a prospective, Dutch multicenter cohort study including 25 patients (12 males, median age 6 (range 2-18) years) with PPI-resistant GERD who were scheduled for LARS. Twenty-four-hour multichannel intraluminal impedance pH monitoring (MII-pH monitoring) was performed before and 3 months after fundoplication. Impedance pH tracings were analyzed for reflux episodes and GBs and SGBs.
  
  
  RESULTS
  LARS reduced acid exposure time from 8.5% (6.0-16.2%) to 0.8% (0.2-2.8%), p < 0.001. The number of GBs also significantly decreased after LARS (59 [43-77] VS 5 [2-12], p < 0.001). The number of air swallows remained unchanged after LARS. SGBs were infrequent before LARS with no change in the number of SGB observed after the procedure. Postoperative belching symptoms were associated with GBs, not with SGBs.
  
  
  CONCLUSIONS
  LARS significantly reduces the number of GBs in children with GERD, whereas the number of air swallows remains unchanged. Postoperative symptomatic belching is associated with GBs, but not with SGBs. These findings suggest that LARS does not induce the occurrence of SGBs in children, but longer follow-up is required.
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. n.rinsma@maastrichtuniversity.nl.
authors.forename: N F
authors.initials: NF
authors.lastname: Rinsma
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F A
authors.initials: FA
authors.lastname: Mauritz
authors.affiliation: Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: L W E
authors.initials: LW
authors.lastname: van Heurn
authors.affiliation: Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: C E J
authors.initials: CE
authors.lastname: Sloots
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Pediatric Gastroenterology and Hepatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: R H J
authors.initials: RH
authors.lastname: Houwen
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: D C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A A M
authors.initials: AA
authors.lastname: Masclee
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Conchillo
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: M Y A
authors.initials: MY
authors.lastname: Van Herwaarden-Lindeboom
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004884:Eructation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D050782:Esophageal pH Monitoring / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000639:trends*; D008297:Male; D011446:Prospective Studies
keywords: belching; gas; gastroesophageal reflux disease; laparoscopic fundoplication; pediatrics