Gastroesophageal Reflux Disease and Need for Antireflux Surgery in Children with Cystic Fibrosis: A Systematic Review on Incidence, Surgical Complications, and Postoperative Outcomes

Abstract Introduction Gastroesophageal reflux disease (GERD) is associated with accelerated decline in lung health in children with cystic fibrosis (CF). Thus, antireflux surgery (ARS) is offered to a selected CF cohort with refractory GERD, but outcomes remain poorly investigated. This study aimed to determine the incidence of GERD in children with CF and to evaluate complications and outcomes of ARS. Materials and Methods A systematic literature-based search was conducted using various online databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The number of GERD cases in pediatric CF cohorts who underwent diagnostic investigation(s) was recorded. Data on postoperative complications and outcomes (including symptoms, lung function, and nutritional status) following ARS were analyzed. Results Ten articles (n = 289 patients) met the defined inclusion criteria (51% male; age range, 0.5 month–36 years). The overall incidence of GERD was 46% (range, 19–81%), derived from seven studies (n = 212 patients). Four publications (n = 82 patients) reported on ARS due to uncontrolled GERD. All ARSs were Nissen fundoplication (majority with gastrostomy placement). Major postoperative complications occurred in 15 (18%) patients, two required redo-ARS. Median follow-up time was 2 years (range, 3 months–6 years); 59% showed symptom improvement, and pulmonary exacerbations and decline in lung function were reduced. Nutritional status mainly improved in milder CF cases. There were no deaths related to ARS. Conclusion Approximately half of pediatric CF patients have GERD. Published data for children with CF are limited and heterogeneous in terms of GERD diagnosis and outcomes following ARS. However, ARS has shown to slow the deterioration of lung function in CF.

Download Full-text

Faculty Opinions recommendation of Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718000906.793475046 ◽

2013 ◽

Author(s):

Keith Meyer

Keyword(s):

Gastroesophageal Reflux Disease ◽

Lung Function ◽

Gastroesophageal Reflux ◽

Lung Transplantation ◽

Lung Disease ◽

Reflux Disease ◽

Antireflux Surgery ◽

Before And After ◽

End Stage

Download Full-text

Antireflux Surgery Preserves Lung Function in Patients With Gastroesophageal Reflux Disease and End-stage Lung Disease Before and After Lung Transplantation

Archives of Surgery ◽

10.1001/archsurg.2011.216 ◽

2011 ◽

Vol 146 (9) ◽

pp. 1041 ◽

Cited By ~ 83

Author(s):

Toshitaka Hoppo

Keyword(s):

Gastroesophageal Reflux Disease ◽

Lung Function ◽

Gastroesophageal Reflux ◽

Lung Transplantation ◽

Lung Disease ◽

Reflux Disease ◽

Antireflux Surgery ◽

Before And After ◽

End Stage

Download Full-text

An integrated approach to treatment of patients with complicated forms of gastroesophageal reflux disease

Kazan medical journal ◽

10.17816/kmj2020-595 ◽

2020 ◽

Vol 101 (4) ◽

pp. 595-602

Author(s):

A A Moroshek ◽

M V Burmistrov

Keyword(s):

Postoperative Complications ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Antireflux Surgery ◽

Main Group ◽

Long Term Results ◽

Control Group ◽

Peptic Stricture

Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease. Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 48 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhibitors omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture. Results. The frequency of intraoperative [6.3% (95% CI 1.45.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.445.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.77.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.193.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.793.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attributable to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance. Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.

Download Full-text

Laparoscopic antireflux surgery with routine hiatoplasty in the treatment of gastroesophageal reflux disease

Gastroenterology ◽

10.1016/s0016-5085(01)82379-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A480-A480

Author(s):

F GRANDERATH ◽

U SCHWEIGER ◽

T KAMOLZ ◽

T BAMMER ◽

M PASIUT ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Antireflux Surgery ◽

Laparoscopic Antireflux Surgery

Download Full-text

Gastroesophageal Reflux Disease: Integrating the Barium Esophagram before and after Antireflux Surgery

Radiology ◽

10.1148/radiol.2432050057 ◽

2007 ◽

Vol 243 (2) ◽

pp. 329-339 ◽

Cited By ~ 29

Author(s):

Mark E. Baker ◽

David M. Einstein ◽

Brian R. Herts ◽

Erick M. Remer ◽

Gaspar Alberto Motta-Ramirez ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Antireflux Surgery ◽

Before And After ◽

Barium Esophagram

Download Full-text

Efficacy and Safety of Robotic Dor Fundoplication on Severe Gastroesophageal Reflux Disease in Patients With Scleroderma

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211051211 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110512

Author(s):

Priyadarshini Loganathan ◽

Mahesh Gajendran ◽

Brian Davis ◽

Richard McCallum

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Surgical Complication ◽

Smooth Muscles ◽

Dor Fundoplication ◽

High Resolution Manometry ◽

Refractory Gerd ◽

Significant Impairment ◽

Gerd Symptoms

Systemic sclerosis (SSc) is a disease that affects the gastrointestinal tract resulting in its atrophy and fibrosis of smooth muscles. Approximately 80% of SSc patients develop both gastroesophageal reflux disease (GERD) and dysphagia. The nocturnal GERD can cause regurgitation and aspiration, which can further aggravate the pulmonary fibrosis from SSc. Also, their dysphagia is further worsened by performing standard Nissen fundoplication. Therefore, we aimed to investigate whether Dor fundoplication (a 180° anterior wrap) can reduce nocturnal heartburn and regurgitation without worsening dysphagia in patients with SSc and severe GERD. Five SSc patients with drug-refractory severe GERD underwent a Dor fundoplication procedure with a median follow-up of 2 years (range: 1-5 years). In all 5 patients, the preoperative high-resolution manometry showed significant impairment of esophageal motility. Patients were interviewed postoperatively to assess for nocturnal and diurnal GERD symptoms, treatment response, the status of dysphagia, and adverse effects of surgery. The average age of 5 patients was 50 years and all were females. Four of the 5 patients (80%) reported 90% improvement in both diurnal and nocturnal GERD symptoms since surgery, with no nocturnal reflux, heartburn, or regurgitation, and reports to sleep at night without requiring any more pillows or wedges. About 50% of patients reported a decrease in their proton pump inhibitor dosage after surgery compared to before surgery. No surgical complication was reported and specifically, no worsening of dysphagia. The Dor fundoplication performed for refractory GERD in SSc patients substantially decreases heartburn and regurgitation, primarily nocturnal, without affecting dysphagia, thus improving the quality of life.

Download Full-text

Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.08.000387 ◽

2019 ◽

Vol 91 (8) ◽

pp. 4-11 ◽

Cited By ~ 2

Author(s):

I V Maev ◽

D N Andreev ◽

Yu A Kucheryavyy ◽

R I Shaburov

Keyword(s):

Molecular Weight ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Mucous Membrane ◽

Reflux Disease ◽

Barrier Function ◽

Poloxamer 407 ◽

Low Molecular Weight ◽

Esophageal Mucosa ◽

Refractory Gerd

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.

Download Full-text