Necessity for Surgery in Children with Gastrooesophageal Reflux and Supraoeslophageal Symptoms

Girolamo Mattioli, O. Sacco, P. Repetto, A. Pini Prato, M. Castagnetti, C. Carlini, M. Torre, S. Leggio, V. Gentilino, F. Martino, B. Fregonese, A. Barabino, P. Gandullia, G. A. Rossi, V. Jasonni

Research output: Contribution to journalArticle

Abstract

Background/Purpose: The majority of gastrooesophageal reflux (GER) manifestations in children are supraoesophageal, and " spitting/posseting" is "the tip of the iceberg" because most reflux episodes are not regurgitated. Aim of the present study was to prospectively evaluate the incidence of gastrooesophageal reflux and the incidence of antireflux surgery in patients with difficult-to-treat respiratory symptoms. Patients and Methods: Five hundred and ninety-five children with difficult-to-treat respiratory symptoms were prospectively enrolled in a blind study looking for the correlation between clinical presentation (asthma or non-asthma), oesophageal pH monitoring, X-ray barium meal, broncho-alveolar lavage, necessity for surgery, and outcome. Results: pH monitoring was anomalous in 47% of patients with asthma (group A) and in 43% of those who did not have asthma as main symptom (group B). Overall, 48 patients finally underwent anti-reflux surgery (8%) as anti-reflux medical treatment did not ensure stable benefits. No major surgical complications were experienced. Postoperatively, respiratory symptoms improved strongly (Visick 1) in 69% of cases, moderately (Visick 2) in 27%, while clinical worsening (Visick 4) was observed in 4%. Conclusions: The results of this study stress the importance of symptoms, clinical response to anti-reflux medical treatment and broncho-alveolar lavage compared to classical pH parameters in the decision-making process for patients with difficult-to-treat supraoesophageal symptoms. To date no single tool alone has proved to be diagnostic in these patients. Fundoplication is recommended only when a relationship between supraoesophageal symptoms and gastrooesophageal reflux is strongly suspected.

Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalEuropean Journal of Pediatric Surgery
Volume14
Issue number1
DOIs
Publication statusPublished - Feb 2004

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Gastroesophageal Reflux
Asthma
Therapeutic Irrigation
Esophageal pH Monitoring
Fundoplication
Incidence
Barium
Meals
Decision Making
X-Rays
Therapeutics

Keywords

  • Asthma
  • Fundoplication
  • Gastrooesophageal reflux
  • PHmetry
  • Surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Necessity for Surgery in Children with Gastrooesophageal Reflux and Supraoeslophageal Symptoms. / Mattioli, Girolamo; Sacco, O.; Repetto, P.; Pini Prato, A.; Castagnetti, M.; Carlini, C.; Torre, M.; Leggio, S.; Gentilino, V.; Martino, F.; Fregonese, B.; Barabino, A.; Gandullia, P.; Rossi, G. A.; Jasonni, V.

In: European Journal of Pediatric Surgery, Vol. 14, No. 1, 02.2004, p. 7-13.

Research output: Contribution to journalArticle

Mattioli, G, Sacco, O, Repetto, P, Pini Prato, A, Castagnetti, M, Carlini, C, Torre, M, Leggio, S, Gentilino, V, Martino, F, Fregonese, B, Barabino, A, Gandullia, P, Rossi, GA & Jasonni, V 2004, 'Necessity for Surgery in Children with Gastrooesophageal Reflux and Supraoeslophageal Symptoms', European Journal of Pediatric Surgery, vol. 14, no. 1, pp. 7-13. https://doi.org/10.1055/s-2004-815773
Mattioli, Girolamo ; Sacco, O. ; Repetto, P. ; Pini Prato, A. ; Castagnetti, M. ; Carlini, C. ; Torre, M. ; Leggio, S. ; Gentilino, V. ; Martino, F. ; Fregonese, B. ; Barabino, A. ; Gandullia, P. ; Rossi, G. A. ; Jasonni, V. / Necessity for Surgery in Children with Gastrooesophageal Reflux and Supraoeslophageal Symptoms. In: European Journal of Pediatric Surgery. 2004 ; Vol. 14, No. 1. pp. 7-13.
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AU - Sacco, O.

AU - Repetto, P.

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AU - Castagnetti, M.

AU - Carlini, C.

AU - Torre, M.

AU - Leggio, S.

AU - Gentilino, V.

AU - Martino, F.

AU - Fregonese, B.

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AU - Rossi, G. A.

AU - Jasonni, V.

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AB - Background/Purpose: The majority of gastrooesophageal reflux (GER) manifestations in children are supraoesophageal, and " spitting/posseting" is "the tip of the iceberg" because most reflux episodes are not regurgitated. Aim of the present study was to prospectively evaluate the incidence of gastrooesophageal reflux and the incidence of antireflux surgery in patients with difficult-to-treat respiratory symptoms. Patients and Methods: Five hundred and ninety-five children with difficult-to-treat respiratory symptoms were prospectively enrolled in a blind study looking for the correlation between clinical presentation (asthma or non-asthma), oesophageal pH monitoring, X-ray barium meal, broncho-alveolar lavage, necessity for surgery, and outcome. Results: pH monitoring was anomalous in 47% of patients with asthma (group A) and in 43% of those who did not have asthma as main symptom (group B). Overall, 48 patients finally underwent anti-reflux surgery (8%) as anti-reflux medical treatment did not ensure stable benefits. No major surgical complications were experienced. Postoperatively, respiratory symptoms improved strongly (Visick 1) in 69% of cases, moderately (Visick 2) in 27%, while clinical worsening (Visick 4) was observed in 4%. Conclusions: The results of this study stress the importance of symptoms, clinical response to anti-reflux medical treatment and broncho-alveolar lavage compared to classical pH parameters in the decision-making process for patients with difficult-to-treat supraoesophageal symptoms. To date no single tool alone has proved to be diagnostic in these patients. Fundoplication is recommended only when a relationship between supraoesophageal symptoms and gastrooesophageal reflux is strongly suspected.

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