Gastroesophageal reflux secondary to gastrostomy tube placement
S. Berezin, S. M. Schwarz, M. S. Halata and L. J. Newman
We evaluated five children with severe psychomotor retardation who
developed frequent vomiting and poor weight gain after surgical placement
of a feeding gastrostomy tube. Prolonged pH probe testing before surgery
did not reveal notable gastroesophageal reflux (GER). Treatment with
12-hour gastrostomy tube feeding resulted in a marked reduction in
vomiting; after one year of continuous feeding, all patients had achieved
significant weight gain (mean, 44.0%). Esophageal manometrics and 24-hour
pH probe testing before and at the end of the 12-month continuous-feeding
period demonstrated low pressures of the lower esophageal sphincter and
significant GER in the five children studied. These results indicate that
children may develop symptomatic GER after gastrostomy tube placement. In
such patients continuous gastrostomy tube feeding may result in a cessation
of vomiting and achievement of significant weight gain. Definitive
antireflux surgery can then be performed with the patient in an improved
nutritional state.
