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GERD Surgery In Babies: A Tricky Decision

Thu, 11/07/2013 - 9:25am
Cole Petrochko

Given the fact that reflux is normal in most infants, determining which patients should be treated surgically requires careful consideration and keen judgment, researchers warned.

The majority of patients receiving surgical antireflux procedures are 6 months old or younger (52.7 percent), and the hazard for progression to such a procedure decreased significantly as patients got older, according to Jarod McAteer, MD, MPH, of Seattle Children's Hospital in Washington, and colleagues.

However, for every gastroesophageal reflux disease (GERD) incident requiring hospitalization, risk of surgical treatment increased by 10 percent (95% CI 1.08-1.12), they wrote online in JAMA Surgery.

The authors cautioned that there is no objective criteria to guide diagnosis and treatment of GERD in pediatric populations. However based on their research, optimal GERD management is a "multistep process beginning with an objective diagnosis of pathologic reflux, followed by a trial of validated medical therapy, and culminating in an informed decision to offer surgical treatment to appropriate candidates," after less invasive therapies fail.

The American Academy of Pediatrics cautioned healthcare professionals to first determine whether a pediatric patient is exhibiting symptoms of gastroesophageal reflux or if that reflux is considered GERD before attempting a course of treatment.

Another study showed parents are more likely to request a drug treatment for infant's reflux, even if the pediatrician said that drugs would not be effective.

McAteer and colleagues conducted a retrospective cohort study of 141,190 hospitalized GERD patients, including 11,621 who underwent antireflux procedures, from 2002 to 2010 and whose patient data were contained in the Pediatric Health Information System. The authors looked to identify factors associated with surgical treatment for reflux in pediatric GERD patients.

Patient variables included sex, age at admission, Medicaid status, and length of hospital stay. Age was grouped by younger than 2 months, 2 to 6 months, 7 months to 4 years, and 5 to 17 years, which "represent break points in the evolution of physiologic regurgitation in children."

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