Gastroesophageal Reflux Disease
Gastroesophageal reflux, with occasional regurgitation of stomach contents up into the esophagus, is common in infants and young children. In most cases, it is not serious or life threatening and gradually resolves with time. Gastroesophageal reflux that interferes with normal functioning is called gastroesophageal reflux disease (GERD) and needs further evaluation.
After a thorough history and physical examination, a child typically will have an upper gastrointestinal (GI) X-ray series. Some children are more comfortable with a parent nearby. WakeMed’s fellowship-trained pediatric radiologists work with parents to allow them to be present in the radiology suite during the test. The test is not painful and involves having the child drink barium, or another contrast liquid, while images are taken of the throat, esophagus and stomach.
Other common tests, which may be helpful in some children, include a nuclear medicine scintiscan (also called a gastric emptying scan), a 24-hour pH probe study or flexible upper endoscopy. Using a small flexible telescope, the physician directs the tube through the mouth and into the stomach to see the esophagus and surrounding region. This test is performed using conscious sedation or anesthesia in an operating room or an endoscopy suite.
Most children with GERD will improve with medical therapy, which typically consists of lifestyle/dietary changes, acid suppressing medications, and, in some cases, medications designed to improve stomach motility. In rare cases, a child will not respond to a trial of medical therapy or may develop symptoms that significantly interfere with normal functioning. This may include regurgitation that irritates the esophagus and causes bleeding (esophagitis and/or esophageal ulceration), reflux that causes so much pain that the child eats poorly and fails to gain weight (“failure to thrive”), and even regurgitation that spills over into the child’s airways causing choking/gagging, asthma and even recurrent respiratory tract infections such as pneumonia.
Making a decision for your child to undergo surgery for severe GERD can be difficult. Our surgeons, nurse practitioner and nurses can explain the surgery and its potential benefits and risks.
Nissen Fundoplication for GERD
Since the early 1960s, the Nissen fundoplication (developed by Dr. Rudolph Nissen) has been the “gold standard” for the surgical treatment of GERD. Although this operation initially required a major incision either through the chest or abdomen, laparoscopic techniques were developed so that most of these operations can now be performed using minimally invasive techniques.
Under general anesthesia, instruments are inserted that allow the surgeon to “wrap” the upper part of the stomach around the esophagus, creating a “valve” mechanism to decrease regurgitation. In addition, sutures are placed to narrow the opening between the chest and the abdomen where the esophagus enters to correct or prevent a hiatus hernia. The operation normally takes one to two hours and requires a short hospitalization. Roughly 90 percent of patients have significant relief of their GERD symptoms following the Nissen operation.
Some children may require other types of fundoplications, including the Dor, Thal, and Toupet. Your surgeon can explain the benefits and risks of each laparoscopic technique.
The International Pediatric Endosurgery Group has published guidelines for minimally invasive treatment of GERD
Learn What to Expect from Nissen Fundoplication for GERD