Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment.
Gastroesophageal reflux (GER), aspiration, and secondary complications lead to morbidity and mortality in children with neurologic impairment (NI), dysphagia, and gastrostomy feeding. Fundoplication and gastrojejunal (GJ) feeding can reduce risk. We compared GJ to fundoplication using first-year postprocedure reflux-related hospitalization (RRH) rates.



We identified children with NI, dysphagia requiring gastrostomy tube feeding and GER undergoing initial GJ placement or fundoplication from January 1, 2007 to December 31, 2012. Data came from the Pediatric Health Information Systems augmented by laboratory, microbiology, and radiology results. GJ placement was ascertained using radiology results and fundoplication by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Subjects were matched within hospital using propensity scores. The primary outcome was first-year postprocedure RRH rate (hospitalization for GER disease, other esophagitis, aspiration pneumonia, other pneumonia, asthma, or mechanical ventilation). Secondary outcomes included failure to thrive, death, repeated initial intervention, crossover intervention, and procedural complications.



We identified 1178 children with fundoplication and 163 with GJ placement, matching 114 per group. Matched sample RRH incident rate per child-year (95% confidence interval) for GJ was 2.07 (1.62-2.64) and for fundoplication 1.67 (1.28-2.18),P= .19. Odds of death were similar between groups. Failure to thrive, repeat of initial intervention, and crossover intervention were more common in the GJ group.



In children with NI, GER, and dysphagia: fundoplication and GJ feeding have similar RRH outcomes. Either intervention can reduce future aspiration risk; the choice can reflect non-RRH-related complication risks, caregiver preference, and clinician recommendation.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; bryan.stone@hsc.utah.edu.
Bryan
B
Stone
Hospital Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
Gabrielle
G
Hester
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Daniel
D
Jackson
Biostatistics, Children's Hospital Association, Overland Park, Kansas.
Troy
T
Richardson
Biostatistics, Children's Hospital Association, Overland Park, Kansas.
Matt
M
Hall
Biomedical Informatics, University of Utah, Salt Lake City, Utah.
Ramkiran
R
Gouripeddi
Biomedical Informatics, University of Utah, Salt Lake City, Utah.
Ryan
R
Butcher
Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Ron
R
Keren
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.|Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, Utah.
Rajendu
R
Srivastava
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000628:therapy*; D004750:Enteral Nutrition; D005183:Failure to Thrive; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D016555:Matched-Pair Analysis; D009422:Nervous System Diseases / Q000150:complications*; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies