ABSTRACT: To study the effect of Nissen fundoplication and gastrostomy in severely neurologically impaired children.
Prospective observational study.
Developmental Disabilities Unit of a regional medical centre in Hong Kong.
Children with severe neurological impairment and gastroesophageal reflux who were institutionalised between 1999 and 2004 inclusive.
Incidence of vomiting, gastro-intestinal bleeding, and pneumonia in the baseline year and consecutive years following surgery; 24-hour oesophageal pH monitoring; recurrence rate (determined by 24-hour oesophageal monitoring); body weight; complications of surgery; and mortality.
Twenty children, with a mean age at surgery of 8.5 (standard deviation, 3.5) years, were recruited. Nissen fundoplication was performed in nine children and 11 children underwent laparoscopic fundoplication. Children were monitored for 1.3 to 5.7 years (median, 3.5 years) after surgery. The incidence of vomiting and gastro-intestinal bleeding was significantly decreased following surgery (P < 0.001 and P = 0.001, respectively; Friedman's test). There was no difference between the preoperative and postoperative incidence of pneumonia (P = 0.973, Friedman's test). The median reflux index was reduced from 5.7% to 0.15% after surgery but six (30%) patients had recurrent gastroesophageal reflux. The mean body weight was 17.4 kg (standard deviation, 4.7 kg) at baseline and 22.8 kg (standard deviation, 4.4 kg) at the end of follow-up (P < 0.05, Student's t test). One patient had mild dumping syndrome soon after fundoplication. One patient had one episode of intestinal obstruction. Four patients died 1.9 to 5.0 years following surgery due to respiratory disease.
Our results indicate that in severely neurologically impaired children with gastroesophageal reflux, vomiting, gastro-intestinal bleeding, and reflux indices based on 24-hour oesophageal pH monitoring were significantly reduced following fundoplication and gastrostomy. The incidence of pneumonia was unchanged. The recurrence rate of reflux was 30% and mortality rate was 20%.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 08/2006; 12(4):282-8.
ABSTRACT: To study the effects of proton pump inhibitors in reducing vomiting, gastrointestinal bleeding, and chest infections in institutionalised neurologically impaired children with gastroesophageal reflux.
A regional hospital, Hong Kong.
Neurologically impaired children with refractory gastroesophageal reflux.
Episodes of vomiting, gastrointestinal bleeding, and pneumonia in the baseline and proton pump inhibitor treatment periods.
Nine children received proton pump inhibitor therapy for a median duration of 81 days. Mean reflux index was 9.3% (standard deviation, 5%). Dosage of omeprazole used was 1.0-2.3 mg/kg/d. Vomiting was reduced significantly with proton pump inhibitor treatment (median vomiting index [baseline]=0.4, median vomiting index [proton pump inhibitors]=0.2; P<0.05). No significant decrease in gastrointestinal bleeding or chest infection was observed.
Proton pump inhibitors significantly reduced vomiting episodes in neurologically impaired children with gastroesophageal reflux.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 12/2001; 7(4):356-9.
ABSTRACT: A 7-year-old Chinese boy presented with acute pancreatitis. The characteristic rash of Henoch-Schonlein purpura (HSP) did not develop until nine days later, together with painful scalp swelling and calf pain. Acute pancreatitis has only rarely been reported in association with HSP and never before as the sole presenting feature.
Journal of Paediatrics and Child Health 07/2001; 37(3):311-3. · 1.28 Impact Factor