Increased Incidence of Delayed Gastric Emptying in Children With Gastroesophageal Reflux

Papaila, John G.; Wilmot, David; Grosfeld, Jay L.; Rescorla, Frederick J.; West, Karen W.; Vane, Dennis W.

doi:10.1001/archsurg.1989.01410080065010

Cited by 90 publications

(37 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some authors have suggested that performing a gastric outlet procedure to facilitate gastric emptying may lessen the incidence of postoperative retching [16]. While pyloroplasty failed to improve our patient's symptoms, reversal of the fundoplication immediately eliminated his gagging and retching.…”

Section: Discussionmentioning

confidence: 66%

Oral dysfunction following nissen fundoplication

Borowitz

1992

Dysphagia

View full text Add to dashboard Cite

In this case report we describe a child with mild neurologic impairment who developed debilitating gagging and retching, and severe oral-motor dysfunction following Nissen fundoplication and gastrostomy tube placement. All oral intake ceased after the operation. Evaluation for postoperative dumping syndrome was negative, and the child's symptoms failed to improve despite numerous medical and surgical measures. However, immediately following reversal of the Nissen fundoplication, the child's gagging and retching ceased, and his oral-motor function began to improve. This is a previously undescribed complication of Nissen fundoplication, a surgical procedure commonly employed in children with neurologic impairment.

show abstract

Section: Discussionmentioning

confidence: 66%

Oral dysfunction following nissen fundoplication

Borowitz

1992

Dysphagia

View full text Add to dashboard Cite

show abstract

“…A range of different techniques (marker dilution, ultrasound, radioscintigraphy, and breath tests) have been used to evaluate gastric emptying of different nutrient/non-nutrient liquid meals (milk formula, apple juice, water). Hillemeier et al [11] first reported delayed gastric emptying in pediatric GERD in 1981, and since that time a number of studies have reported both normal [30,40,[42][43][44][45] and delayed [12,16,[46][47][48][49] gastric emptying in infants and children with GERD. LiVoti et al [49] reported, in a group of infants with GERD (based on confirmation by barium study and pH monitoring), that only 15% of patients had true delayed gastric emptying.…”

Section: Gastric Emptyingmentioning

confidence: 99%

“…Nevertheless, it is clear that gastric motor function is impaired, leading to delayed gastric emptying in a few well-defined subgroups of patients at the severe end of the reflux spectrum. This is particularly true of those with failure to thrive and/or vomiting, which is most evident when associated with neurologic or respiratory disease [11,12,16,48].…”

Section: Gastric Emptyingmentioning

confidence: 99%

Pathophysiological mechanisms of Gastroesophageal reflux disease in children

Davidson

Omari

2001

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Gastroesophageal reflux (GER) is an extremely common pediatric problem, but only in the past few years have we developed a better understanding of its pathophysiology. This is related to the wider use of investigative tools such as flexible endoscopy, 24-hour pH monitoring, and more recently, micromanometric methods and noninvasive breath tests, which have been particularly useful in infants. This paper reviews our current understanding of the esophageal and gastric mechanisms contributing to the pathophysiology of GER. In this context, we also highlight areas where new therapeutic approaches may be beneficial.

show abstract

“…Fundoplication probably achieves these beneficial results on TLESRs by simply decreasing fundal capacity (and thus increasing fundal tone) and also perhaps by fundal denervation (which would decrease receptive relaxation and thus fundal accommodation). Though these phenomena might seem counterproductive in treating patients with GERD, their speeding of gastric emptying may play a more important role than their intuitive potential to trigger more TLESRs [3][4][5].…”

Section: Opinion Statementmentioning

confidence: 99%

“…Special points Ambiguity exists in regard to the efficacy of gastric drainage procedures for improving the delayed gastric emptying that is found in an important subgroup of children with GERD [1••, [3][4][5]. Gastric drainage even has been performed in a few children without fundoplication as isolated therapy for GERD [40].…”

Section: Gastric Drainage For Delayed Gastric Emptying Accompanying Rmentioning

confidence: 99%

Postfundoplication complications in children

Orenstein

Lorenzo

2001

Curr Treat Options Gastro

View full text Add to dashboard Cite

The optimal "treatment" of postfundoplication complications is preoperative prevention of them. Nonreflux causes of the symptom prompting surgery should be carefully eliminated preoperatively. Failure to respond to optimal powerful antireflux pharmacotherapy suggests that GERD was not the cause of symptoms. Neurologic or respiratory disease, delayed gastric emptying or retching, short esophagus, and esophageal dysmotility may predispose patients to complications, and may require careful tailoring of the fundoplication. The optimal antireflux surgery, with a wrap neither too loose nor too tight, may require a nadir lower esophageal sphincter pressure of more than 5 mm Hg to prevent reflux, but less than some value to prevent dysphagia. This latter value may be approximately 10 mm Hg, but depends on swallowing parameters such as peristaltic pressure, lower esophageal sphincter opening diameter, swallowed bolus diameter, and other considerations. Infants may require a gastrostomy tube for venting because of their lower gastric compliance to deal with swallowed air. Children with delayed gastric emptying may benefit from pyloroplasty, but this is debated. When complications occur, re-evaluate the diagnosis and the competence of the fundoplication with barium fluoroscopy, endoscopy with histology, pH probe, and other modalities as indicated. Initially try conservative management of the patient's complications, including dietary and feeding modifications. Give a trial of antireflux pharmacotherapy for recurrent reflux or pharmacotherapy directed at the specific side-effect of the fundoplication if one is present. Consider endoscopically dilating a persistently tight wrap or surgically revising the fundoplication if it is suggested by the evaluation.

show abstract

Increased Incidence of Delayed Gastric Emptying in Children With Gastroesophageal Reflux

Cited by 90 publications

References 33 publications

Oral dysfunction following nissen fundoplication

Oral dysfunction following nissen fundoplication

Pathophysiological mechanisms of Gastroesophageal reflux disease in children

Postfundoplication complications in children

Contact Info

Product

Resources

About