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Study Suggests Surgery Is Not the Best Solution for Children Over 3 Years Old with Gastroesophageal Reflux Disease

December 04, 2006

 A study by researchers at Children’s suggests that some children with gastroesphageal reflux disease may not benefit from operations developed to treat it.

A study by researchers at Children’s suggests that some children with gastroesphageal reflux disease may not benefit from operations developed to treat it. The study appears in the December issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

Gastroesophageal Reflux Disease (GERD) is a problem that affects a large number of children in the United States. Anti-reflux surgical procedures (ARPs) are increasingly offered to control the symptoms. In some medical centers, ARPs are now the third most frequently performed operation in children.

According to data used for a study published in the Journal of the American College of Surgeons in 2002, more than 35,000 pediatric anti-reflux operations were performed between 1992 and 1997.

“Gastresophageal relux affects a huge number of children. Unfortunately, the disease is not well understood and consequently, the true efficacy of the operation is not clear.

Our research is the beginning to uncovering this problem so that, as physicians and parents, we can make more informed choices regarding the care of our children that will lead to better outcomes.” said Dr. Adam Goldin, surgeon and lead author of the study from Children’s Hospital and Regional Medical Center in Seattle.

The purpose of the study was to determine if pediatric anti-reflux procedures (ARPs) were associated with a decreased rate of reflux-related hospitalizations.

Researchers looked at hospital discharge reports from the Washington State Comprehensive Hospital Abstract Report System (CHARS) during the 15-year period from 1987 to 2001, for patients less than 19 years old who had received an anti-reflux procedure.

The study found that in general, ARP was associated with an overall decrease in rate of hospitalizations for reflux-related events, such as aspiration pneumonia, esophagitis, esophageal reflux or days on a ventilator.

The data suggest that children who have had an operation to treat reflux in the first year of life have a 65% lower rate of hospitalizations after the operation, and children who have had an operation between the ages of 1 and 3 years have a 45% lower rate.

Children over age 3, however, did not have a significantly lower rate of hospitalizations for reflux-related events. The study concludes that while anti-reflux procedures are associated with fewer subsequent hospitalizations for younger children, the benefit in older children is less clear.

“We are in the process of performing several studies that will further define gastroesophageal reflux disease, as well as the impact of the disease on the quality of life of the children and families who suffer from it. Our intention is to define characteristics of children that undergo these operations successfully so we can predict which children are truly most likely to benefit from these operations” concluded Dr. Goldin.

In addition to Dr. Goldin, other authors of the study are Robert Sawin, MD, MS, Chief, Department of Pediatric and Thoracic Surgery, Children’s Hospital and Regional Medical Center; Kristy Seidel, MS, Children’s Hospital and Regional Medical Center; and David R. Flum, MD, MPH, Department of General Surgery, University of Washington, Seattle.

Read a complete copy of the study.

About Seattle Children's Hospital

Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Children’s has been delivering superior patient care and advancing new treatments through pediatric research. Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit http://www.seattlechildrens.org.

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