Is there a changing trend in surgical management of gastroesophageal reflux disease in children?

Table 1 Clinical manifestations of GORD[11]

	GOR	GORD
Symptoms	'Happy sitter'	Regurgitation/persistent vomiting/feeding refusal/ hypersalivation
		Arching/irritability/persistent crying
	Regurgitation	Abdominal pain/heart burn/ hematemesis/chest pain
	Vomiting but thriving	Sleep disturbance
		Silent reflux- stridor, wheezing, cough
		Sandifer’s syndrome - head turning episodes to lengthen the oesophagus and LES pressure; repetitive stretching and arching, which gives the appearance of seizure/dystonia
Complications	GORD	Esophagitis/failure to thrive
	Esophagitis	Reactive airway disease/ recurrent pneumonia
		Apnoea/bradycardia/acute life threatening events
		Barrett’s esophagus/esophageal ulceration and perforation/ stricture formation
		Anaemia/seizure

Table 2 Disorders that have been associated with symptomatic GORD[2]

Neurological	Mental retardation from any cause
	Brain injury from any cause
	Cerebral palsy
	Down’s syndrome
	Microcephaly
	Seizure disorders
	Mobius syndrome
	Cornelia-de lange syndrome
	Hydrocephalus
Gastrointestinal	Gastric outlet obstruction from any cause
	Esophageal atresia
	Pharyngeal swallowing uncoordination
	Congenital duodenal obstruction (Ladd’s band, diaphragm)
	Congenital abdominal defects (omphalocele, gastroschisis)
	Short bowel syndrome
	Hirschsprung’s disease
	Portal hypertension
	Ascites
Cardiac	Anomalies causing left heart failure
Respiratory	Congenital diaphragmatic hernia
	Tracheal or subglottic stenosis
	Cleft palate
	Pierre Robin syndrome
	Phrenic nerve palsy
	Bronchopulmonary dysplasia
Prematurity
Multiple anomalies

Table 3 Benefits and limitations of commonly used diagnostic tests

Study	Advantages	Disadvantages
Barium esophagram	Readily available	Inadequate screen for GORD
	Evaluates upper GI structure	Results are operator dependent
24-h pH probe	Quantification of reflux	Requires hospitalization
	Evaluates atypical symptoms Monitors medical treatment	Requires special equipment and trained personnel
Endoscopy with biopsy	Evaluates persistent GORD, PUD, H Pylori infection, allergic enteropathy and Barrett’s oesophagus	Invasive and requires sedation/general anaesthesia