Gastroesophageal Reflux Disease

  • Thane Blinman


Few topics in pediatric surgery spark more disagreement and foster more misunderstandings about pathophysiology and management than gastroesophageal reflux disease. The picture is confounded by the differences between small children and adults, the vastly higher energy (and volume) requirements of babies, the preponderance of non-acid reflux, the poorly defined accuracy of the diagnostic tests for reflux, the questionable effectiveness of “anti-reflux” medications, and the variations of technique and experience of surgeons. Further, there are sometimes troubling complications that can occur after anti-reflux surgery, often made worse by feckless attempts to manage the postoperative patients without regard for the mechanical constraints fundoplasty imposes on the performance and regulation of the gastrointestinal tract. It is important to consider GERD as a mechanical disease and ­surgical treatment of reflux as a way to provide a specific mechanical solution, and to take into account the biomechanics of reflux and its amelioration.


Gastric Emptying Hiatal Hernia Eosinophilic Esophagitis Peristaltic Wave Esophageal Length 
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Suggested Reading

  1. International Pediatric Endosurgery Group Standards and Safety Committee. IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A. 2008;18(6):x–xv.CrossRefGoogle Scholar
  2. Lindeboom MYA et al. Function of the proximal stomach after partial versus complete laparoscopic fundoplication. Am J Gastroenterol. 2003;98(2):284–90.CrossRefPubMedGoogle Scholar
  3. Lobe TE. The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children. Surg Endosc. 2007;21:167–74.CrossRefPubMedGoogle Scholar
  4. Pandolfino JE et al. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol. 2002;282:G1052–8.PubMedGoogle Scholar
  5. Spitz L, McLeod E. Gastroesophageal reflux. Semin Pediatr Surg. 2003;12(4):237–40.CrossRefPubMedGoogle Scholar
  6. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery, from Bowditch to laparoscopy. Ann Surg. 2005;241(1):185–93.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.General, Thoracic and Fetal SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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