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Pediatric GERD Procedures

Pediatric GERD Procedures

Clinicians often have difficulty diagnosing GERD and discriminating it from physiologic regurgitation, especially in the pediatric population. “Childhood GERD is diagnosed commonly by clinical evaluation and often without the use of objective measures,” explains Cabrini LaRiviere, MD, MPH. A GERD diagnosis may remain, especially in young infants, until symptoms wane as part of the natural history of regurgitation or until an objective test disproves the presence of the disease. Helpful New Data Some studies have suggested that infants with GERD are more likely than older children to undergo anti-reflux procedures. However, information is lacking on these trends and often does not control for other comorbidities that can serve as indicators for anti-reflux procedures. In JAMA Surgery, Dr. LaRiviere and colleagues published work that examined infants and children with GERD who required inpatient hospitalization and a subpopulation that progressed to anti-reflux procedures. The analysis included 141,190 children with GERD, 8.2% of whom underwent anti-reflux procedures during the 9-year study period. More than half of patients undergoing these procedures were 6 months of age or younger. Although about two-thirds of children receiving anti-reflux procedures had preoperative upper gastrointestinal tract fluoroscopy, the study found that these patients did not undergo a uniform workup. “Physiologic regurgitation is common in infancy,” says Dr. LaRiviere. “In most infants, this doesn’t lead to prolonged medication use or hospitalization. In fact, this reflux in infancy typically resolves spontaneously. The challenge is that pediatricians and surgeons must determine which cases of regurgitation represent pathologic GERD and which cases might ultimately require operative intervention. We still need a clearer understanding of the role of patient age in GERD to...
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