Gastro-oesophageal reflux and feeding problems after gastrostomy in children with severe neurological impairment

• Published in: Developmental medicine and child neurology Vol. 37; no. 4; p. 320
• Main Authors: Heine, R G, Reddihough, D S, Catto-Smith, A G
• Format: Journal Article
• Language: English
• Published: England 01-04-1995
• Subjects: Adolescent; Body Weight; Child; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Enteral Nutrition - methods; Esophagitis - complications; Esophagitis - physiopathology; Female; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - etiology; Gastrostomy - methods; Humans; Male; Nervous System Diseases - complications; Nervous System Diseases - physiopathology; Severity of Illness Index; Weight Gain
• ISSN: 0012-1622
• DOI: 10.1111/j.1469-8749.1995.tb12010.x

This study evaluated the effect of percutaneous endoscopic gastrostomy (PEG) on the feeding problems and gastro-oesophageal reflux (GOR) of 30 consecutive children with severe neurological impairment who had PEG between October 1990 and March 1993. Evaluation was by questionnaire, clinical history, examination, 24-hour oesophageal pH monitoring and endoscopy. Gastrostomy placement significantly reduced feeding time, feed-related choking episodes and frequency of chest infections. Family stress was significantly reduced in two-thirds of cases. Significant weight-gain occurred. The clinical severity of GOR was significantly increased in eight patients and fundoplication was required in five. 24-hour oesophageal pH measurements before PEG did not reliably predict subsequently increased GOR. Seven patients died, but their deaths were apparently unrelated to GOR. PEG effectively provides nutrition, improves feed-related stresses, but may exacerbate GOR.