[Primary ad secondary gastro-esophageal reflux in pediatric age].

AIM: This study takes into consideration children traited for: a) "primary" gastro-esophageal reflux (GER); b) GER "secondary" to delayed gastric emptying; c) some congenital anomalies which can cause or favour GER in pediatric age.

METHODS

During 2002, 21 infants or children operated on for "primary" or "secondary" GER and 62 patients operated on for esophageal atresia, diaphragmatic hernia or abdominal wall defect were followed-up to evaluate the frequency and the course of post-operative GER.

RESULTS

Patients with "primary" GER had 14% relapses after partial or total fundoplication; all patients with "secondary" GER submitted to fundoplication, usually associated to pyloroplasty, had 0% relapses. One child, after Bianchi's operation, developed an erosive gastritis. Variable degrees of GER developed in 43% of patients operated on for esophageal atresia, in 25% for congenital diaphragmatic hernia and in 0% for abdominal wall defect. In 90% of GER occurred after treatment of esophageal atresia and in 100% of diaphragmatic hernia (predominantely "acquired") an exclusively medical therapy was successfully performed.

CONCLUSION

The conclusion is drawn that: a) the relatively high percentage of relapses after fundoplication in "primary" GER may be related to an incorrect classification of a few number of cases ("secondary" GER considered--and treated--like "primary" GER in the '70s and '80s years?); b) fundoplication associated to a best gastric-emptying operation (pyloroplasty) may lead to excellent results in secondary GER; c) esophageal atresia and congenital diaphragmatic hernia (not including the abdominal wall defects) can cause GER in most cases responsive to simple medical therapy.