Gastroesophageal reflux (GER) is defined as the involuntary passage of stomach contents into the esophagus in children. Slightly more complex mechanisms are effective in reflux disease in children compared to adults. Pathological reflux is often seen in children with neurological disease. These children also have difficulties in swallowing, spastic appearance, and increased hiccup reflex. The gastric emptying times of these children are impaired, and the movements of the esophagus are reduced. In normal children, reflux disease manifests itself with reactive airways, asthma, and frequent episodes of pneumonia. There may be signs of the digestive system such as growth retardation, restlessness, reluctance to eat, chest burning, bloody vomiting, and pain when eating. Continuous contractions trigger reflux in children with neurological disease. Contractions and reflux increase the patient’s caloric needs. Malnutrition due to reflux negatively affects the quality of life. Reflux treatment is recommended for a more comfortable life in these patients.
In the treatment of reflux, priority is given to the measures taken without surgery. It is recommended to give babies with reflux a thicker formula, to feed them upright, to feed less and often, and to lie face down. If the vomiting does not go away, drugs that accelerate gastric emptying and drugs that reduce gastric acid secretion are added to the treatment.
In cases where there is no response to medical treatment, surgical treatment is applied. These;
The child’s failure to gain weight despite drug treatment, Respiratory arrest (apnea) seizures, Severe anemia due to bleeding, stenosis and nutritional deficiency due to esophageal irritation, In older children; Chest pains due to esophageal irritation, loss of appetite and weight loss, Recurrent lung infections due to escape to the respiratory tract, Detection of gastric hernia
The surgical treatment methods preferred in reflux disease in children show parallelism with adult patients. Laparoscopic (closed) surgery methods are primarily preferred in children as in adults. The most preferred method is the laparoscopic Nissen fundoplication. In this surgery, the upper part of the stomach is wrapped around the part of the esophagus in the abdomen. During reflux, this wrapped part is expected to fill with stomach contents, compressing the esophagus and preventing the contents from escaping upwards.
The success of these surgeries is between 85 and 94%. Although complaints such as gas entrapment syndrome, indigestion after rapid gastric emptying, inability to vomit and small-volume feeding are observed after the surgery, they usually disappear in 6 months.
