Antireflux Procedures for GERD

Nov 9, 2013
Study Evaluates Antireflux Procedures for Gastroesophageal Reflux Disease

Among hospitalized children diagnosed with gastroesophageal reflux disease (GERD, regurgitation), infants younger than 2 months are more likely than older infants to undergo surgical antireflux procedures (ARPs), even though GERD in that age group is normal and resolves itself in many cases, according to a study by Jarod McAteer, M.D., M.P.H., of Seattle Children’s Hospital, and colleagues.

GERD is a common diagnosis in infants and children, and ARPS are one of the most common procedures performed by pediatric general surgeons. But ARPS are performed at a time in an infant’s life when regurgitation is normal and resolves itself in many cases.

Of the 141,190 participants (younger than 18 years of age) in the study, 11,621 (8.2 percent) underwent ARPs and more than half of the patients undergoing ARPs (52.7 percent) were 6 months or younger. The chance of having an ARP was decreased in children ages 7 months to 4 years and 5 to 17 years compared to children younger than 2 months, according to the study results. Most of the patients in the ARP group also did not undergo a uniform workup.

“Given what this study shows regarding the current state of practice at tertiary pediatric hospitals, a greater effort is needed to develop and disseminate best-practice standards for the diagnosis and treatment of children, especially infants, with possible GERD. We must clarify the indications for ARP and clarify its use to treat GERD vs. its use as an adjunct to a durable long-term feeding plan,” the study concludes.

(JAMA Surgery. Published online November 6, 2013. doi:10.1001/jamasurg.2013.2685.