EN
TÜRKÇE
Poster With Presentation - 32
EVALUATION OF SURGERY VERSUS MEDICAL APPROACH AND THE ROLE OF GUIDE LINES IN THE MANAGEMENT OF GASTROESOPHAGEAL REFLUX IN PEDIATRICS
MJ Aboud
The Maternity and Child Teaching Hospital/Al-Qadisiya -Iraq Ministry of Health
INTRODUCTION : Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal problems that occurs in children. The term refers to the presence of gastric contents proximal to the stomach. It is not uncommon for many infants to have recurrent problems of spitting up and vomiting during the first year of life. Treatment of GERD is directed at the various identified pathophysiological components. The majority of infants can be successfully treated conservatively while awaiting improvement as spontaneous maturation of the physiological antireflux mechanisms occurs. The goals of an antireflux operation are to relieve reflux symptoms, decrease GERD-related complications and hospitalizations, and halt the use of antireflux medications.
OBJECTIVE : This study represented the alternatives for managing the acute and chronic symptoms of uncomplicated GERD in patients who may require long-term treatment. It summarizes the role of guide lines and available evidence comparing the efficacy and safety of medical, and surgical interventions in the treatment of GERD, particularly after long-term follow up.
MATERIALS AND METHODS : From January 2005 to January 2010 , 26 children have been treated for GER , 14 with medical approach ( primarily involves prokinetic agents and acid suppression therapy )and 12 with antireflux surgery ( 6 with Thal,s operation and 6Nissen fundoplication ) at the Maternity and Children Teaching Hospital in Al-Qadisiya , Iraq. A review of the hospital records of these patients was performed. Twenty one of these children have been followed for an average of 12 months; the remaining 3 have been lost to follow-up.Questions addressed in this report are: What is the evidence of the comparative effectiveness of medical, and surgical treatments for improving objective and subjective outcomes in patients with chronic GERD? Is there evidence that effectiveness of medical, and surgical treatments varies for specific patient subgroups? What are the short- and long-term adverse effects associated with specific medical, and surgical therapies for GERD? .
RESULTS : The number of patients requiring antireflux medications decreased from 12 patients (46.1%) before antireflux surgery to 4 (15.3%) after antireflux surgery,3 were restarted on antireflux medications within 1 year after surgery.Vomiting was the most common presenting symptom of recurrent reflux, which occurred an average of 3-8 months following the initial antireflux or fundoplication . Recurrent reflux occurred in 3 children and was documented with upper gastrointestinal radiography .
CONCLUSION : Investigation of these diseases can be specific and accurate. Therapy is available, but no drug will stop reflux. Some children suffer intractable GERD with secondary complications GERD despite medical treatment. Failure of therapy could mean patients require surgical intervention.Antireflux surgery and fundoplication is well established as the surgical treatment for medically refractory GERD occurring in childhood. High technical standards and rigorous report of the results are required for keeping a relevant place of pediatric surgery in the treatment of this disease.