Gastroesophageal Reflux Secondary to Gastrostomy Tube Placement

Berezin, Stuart; Schwarz, Steven M.; Halata, Michael S.; Newman, Leonard S.

doi:10.1001/archpedi.1986.02140210097034

Cited by 34 publications

(14 citation statements)

References 9 publications

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“…This was previously reported by the research authors S. Berezin, S. M. Schwarz and M. S. Halata (1986), who demonstrated that neurologically weakened babies had a lower pressure in the lower esophageal sphincter that predisposed both reflux and a recurrent respiratory infection [14].…”

Section: Discussionsupporting

confidence: 73%

Current Approaches to the Treatment of Gastroesophageal Reflux Disease in Children with Neurology

Ахпаров¹

2019

AJP

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The incidence of gastroesophageal reflux in children with neurological disorders is more common than in the rest of the pediatric population. The risk of reflux development in these children is due to abnormal motility of the gastrointestinal tract, their long term staying in bed (a horizontal position), a disruption of the swallowing process, a delayed evacuation of food from the esophagus and stomach, and a weakened muscle tone that pose a serious threat to a patient by possible complications (such as reflux esophagitis, peptic stricture, erosion and bleeding), and sometimes being one of the causes of death. From 2008 to 2018, 128 patients with gastroesophageal reflux disease were hospitalized in the Department of Surgery of the Scientific Center for Pediatrics and Pediatric Surgery including 33 (26%) children with neurological disorders, of which 28 (85%) were operated. All of the patients underwent Nissen esophagofundoplications, of which in 21 (75%) children it was combined with Stamm gastrostomy and in 18 (64%) children with Mikulich pyloroplasty. The results of surgical treatment were analysed in all the 28 patients in the early period (7-14 days) after surgery. In 2 (7%) children who did not undergo the pyloroplasty there was a complication in the form of gastric distress syndrome, which required an additional surgery in order to drain the stomach. A relapse of gastroesophageal reflux disease was observed in 1 (4%) patient who was re-operated. In the remaining 25 (89%) children, the postoperative period was favourable. Their gastrostomy tube feeding was carried out according to the age requirements. The long-term results were studied in time interval from 6 months to 3 years after surgery. X-ray control examination, fibroendoscopy and 24-hour pH monitoring were conducted in all children in the distant period. The results of the treatment are favourable, the weight deficit is filled, the reflux esophagitis is stopped and the refluxassociated inflammations of the bronchopulmonary system are reduced. To a large extent, the choice of operational tactics can be adapted to the condition of a particular child, the results of objective and instrumental tests for GERD, the pseudobulbar disorders and associated pyloric functional disorders. Timely correction of reflux disorders in children with pathologies of the central nervous system helps prevent the development of serious complications, which will inevitably improve a child's quality of life.

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Section: Discussionsupporting

confidence: 73%

Current Approaches to the Treatment of Gastroesophageal Reflux Disease in Children with Neurology

Ахпаров¹

2019

AJP

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“…13,[16][17][18] Many patients with recurrent aspiration have PEG tubes placed; however, PEG tube feeding is associated with aspiration in 30% to 95% of patients, and no decrease in aspiration and/or pneumonia has been demonstrated. 1,[19][20][21][22] Enteral feeding more distally in the gastrointestinal tract, which may decrease gastroesophageal reflux, has been used in an attempt to address this problem. 2,3,5 This is most commonly done using a PEG-J tube.…”

Section: Discussionmentioning

confidence: 99%

“…First, gastric feeding may increase the rate of gastroesophageal reflux. [20][21][22][23] Second, compared with the PEG-J tube, there is a more reliable delivery of feeding formula into the jejunum. 11,24 Also, the DPEJ tube, unlike the PEG-J tube, does not cross the pylorus and therefore may cause less duodenogastric reflux.…”

Section: Discussionmentioning

confidence: 99%

DPEJ Tube Placement Prevents Aspiration Pneumonia in High‐Risk Patients

et al. 2008

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Percutaneous endoscopic gastrostomy (PEG) or PEG tube with transgastric jejunostomy tube (PEG-J) feeding has not been shown to decrease aspiration pneumonia. The aim of this study was to determine if direct percutaneous endoscopic jejunostomy (DPEJ) tube placement results in a decreased incidence of aspiration pneumonia in high-risk patients. The design was a retrospective review of all patients receiving DPEJ tube for aspiration pneumonia from 1999 to 2005. Demographics, incidence of aspiration pneumonia, and outcomes were collected and compared before and after the DPEJ placement. Eleven patients (4 women, 7 men) were identified; their mean age was 44.9 years (range, 18-94 years). The etiologies for recurrent aspiration pneumonia were neurologic disease (9), esophageal surgery (1), and severe debilitation (1). The mean follow-up was 20.9 months (range, 6-48 months). The patients' mean weight increased from 43.8 kg (range, 19-55 kg) to 48.3 kg (range, 30-65 kg) after placement (P < .001). The total number of documented aspiration pneumonia episodes for all patients decreased from 29 (mean, 3.64; range, 1-6) before DPEJ placement to 3 (mean, 0.27; range, 0-2) after DPEJ placement (P < .001). The mean number of aspiration pneumonia events per month prior to the DPEJ placement was 3.39 and postplacement was 0.42 (P < .001). DPEJ placement appears to decrease recurrent aspiration pneumonia in patients with history of aspiration pneumonia.

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“…Continuous feedings may minimize the overt symptoms of reflux in some children and adults. (Berezin et al, 1986;Coben, Weintraub, DiMarino, & Cohen, 1994). Unfortunately, no preoperative testing has been found to predict the development of GERD postoperatively.…”

Section: Without Fundoplicatimmentioning

confidence: 99%

Gastroesophageal Reflux Disease and Dysphagia in Children

Putnam¹

1997

Semin Speech Lang

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Gastroesophageal reflux disease (GERD) is a common problem in children that is sometimes associated with dysphagia. Choking, food refusal, and food "getting stuck" are non-specific symptoms that may arise consequent to reflux and esophagitis. Swallowing plays a role in reflux physiology, functioning as a major clearance mechanism after reflux episodes. Therefore, failure of swallowing to effectively perform that function contributes to reflux pathophysiology. The diagnosis and treatment of GERD in children must be carried out systematically and thoroughly. Multiple interacting factors are common, thus complicating the process.

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Gastroesophageal Reflux Secondary to Gastrostomy Tube Placement

Cited by 34 publications

References 9 publications

Current Approaches to the Treatment of Gastroesophageal Reflux Disease in Children with Neurology

Current Approaches to the Treatment of Gastroesophageal Reflux Disease in Children with Neurology

DPEJ Tube Placement Prevents Aspiration Pneumonia in High‐Risk Patients

Gastroesophageal Reflux Disease and Dysphagia in Children

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