Gastroesophageal reflux in the severely retarded who vomit: criteria for and results of surgical intervention in twenty-two patients.

Forty-two severely retarded patients, ranging in age from 2 to 26 years, were referred for diagnostic evaluation because of chronic vomiting. The diagnosis of gastroesophageal reflux (GER) was made in 28 of the basis of reflux (grade III) on upper gastrointestinal series and the presence of esophagitis either grossly at endoscopy or on esophageal biopsy. Nissen fundoplication was performed in 22 because of the frequent occurrence of complications such as pneumonia, gastrointestinal blood loss, and malnutrition attributable to GER. The incidence of postoperative complications was 59%. However, during a mean follow-up period of 14.1 months, no further vomiting or gastrointestinal blood loss was encountered, and only one patient had a single episode of pneumonia. Weight gain in those who were malnourished was impressive. In addition, the already difficult care of the patients was greatly facilitated. Severely retarded patients with GER who suffer recurrent complications should be considered for Nissen fundoplication.