Gastroesophageal reflux disease in children
What is gastroesophageal reflux disease, what are its symptoms, how is it diagnosed and treated, says Valery Khairullaevich Faizullaev, a pediatric surgeon and head of the pediatric surgical department of the Northern Clinic.
Faizullaev Valery Khairullaevich Surgeon
Hello. My name is Valery Khairullaevich Faizullaev. I am a pediatric surgeon, head of the surgical department of the Scandinavia clinic.
I would like to talk about a disease that is common nowadays, gastroesophageal reflux disease. The disease gastroesophageal reflux disease includes esophageal and extraesophageal manifestations. For a long time, children may complain of problems such as pain in the chest, an obsessive cough, which neither a pediatrician, nor an allergist, nor a bronchologist can diagnose. This is abdominal pain, this is the inability to digest food, accompanied by vomiting, these are chronic otitis media, which are treated for a long time by specialists of the ENT service, and the causes of this disease are not always clear. These are caries, when carious teeth are treated for a long time, and the cause of all this is gastroesophageal reflux disease.
So, we have listed practically complaints relating to the respiratory system and oral cavity and gastrointestinal tract diseases. Gastroesophageal reflux disease or the most pronounced symptom is gastroesophageal reflux, that is, reflux from the stomach into the esophagus occurs from the neonatal period to old age. Why is it fundamentally important to deal with this problem at an early age? Because it is possible to avoid a number of such complications in the future, such as aspiration pneumonia, or such common diseases in adolescence or adulthood as Baretto esophagus, this disease is precancerous - a change in the mucosa, metaplasia of the esophageal mucosa, which is a precancerous condition.
All these serious complications can be avoided in the future if the diagnosis is made in time. Surgical treatment is not always required. If the condition is identified in the early period, then the disease can be managed conservatively, except in cases where there is an anatomical predisposition, for example, hiatal hernia, which, unfortunately, is not so rare; in more than 50% of cases the disease is gastroesophageal reflux disease accompanied by the presence of a hernia.
The complex of diagnostic studies includes 3 main components. The first is fibrogastroduodenoscopy, that is, with the help of precise optics we examine the condition of the esophagus and stomach. Variants such as anatomical hiatus hernias are most often visible; we also detect changes in the mucous membrane of the esophagus and stomach.
The next stage of diagnosis is an x-ray contrast study, during which the degree of reflux of stomach contents into the esophagus is determined. The third component of the study is PH-metry, that is, determination of the acidity of the stomach and esophagus. The purity of reflux from the stomach into the esophagus is determined by this method and the state of acidity in cavities such as the esophagus and stomach.
Our clinic uses the most modern surgical treatment measures to correct this disease, gastroesophageal reflux disease. They are minimally invasive and endoscopic. The approaches are so minimal that in the postoperative period there are practically no visible marks on the abdomen. High-precision optics and high-precision instruments are used for surgical treatment. During the operation, the most modern anesthesia drugs are used, which children can easily tolerate and in the postoperative period this allows us to avoid a number of complications.
Surgical treatment is a radical treatment; after correction, the patient is completely cured. The child returns to a full life. He avoids not only the complications of this disease, in the future, in adulthood, but also almost completely forgets about what problems he had. In the postoperative period, the child is still observed for some time by a surgeon and gastroenterologist. Then the family almost completely forgets about this disease and returns to a full life.
Date of publication: 07.19.16
Severe gastroesophageal reflux disease in children: causes and treatment approaches
A.A. KAMALOVA, V.P. BULATOV
Kazan State Medical University, 420012, Kazan, st. Butlerova, 49
Kamalova Aelita Askhatovna - Doctor of Medical Sciences, Associate Professor of the Department of Hospital Pediatrics, tel., e-mail
Bulatov Vladimir Petrovich - Doctor of Medical Sciences, Professor, Head of the Department of Hospital Pediatrics, tel. (843) 237-30-37, e-mail
Despite the developed algorithms for the diagnosis and treatment of gastroesophageal reflux disease in children, there is a group of patients predisposed to a severe course of the disease, requiring an individual approach and long-term observation due to the risk of subsequently developing such serious complications as Barrett's esophagus and esophageal adenocarcinoma. The article describes conditions and diseases associated with severe gastroesophageal reflux disease. Approaches to therapy and evaluation of various treatment methods are presented.
Key words: gastroesophageal reflux disease, children, severe course.
AA KAMALOVA, VP BULATOV
Kazan State Medical University, Butlerov St., 49, Kazan, Russian Federation, 420012
Severe gastroesophageal reflux disease in children: causes and treatment approaches
Kamalova A.A. - D. Med. Sc., Associate Professor of the Department of Pediatrics, tel., e-mail Bulatov VP - D. Med. Sc., Professor, Head of the Department of Pediatrics, tel. (843) 237-30-37, e-mail
Despite the developed algorithms for diagnosis and treatment of the gastroesophageal reflux disease in children, there is a group of patients prone to severe disease that require individual approach and long-term monitoring because of the risk of subsequent serious complications such as Barrett's esophagus and esophageal adenocarcinoma . The article describes the conditions and diseases associated with severe gastroesophageal reflux disease. The approaches to the treatment and its evaluation are presented.
Key words: gastroesophageal reflux disease, children, severe course.
According to the working protocol for the diagnosis and treatment of gastroesophageal reflux disease in children, adopted at the XX Congress of Pediatric Gastroenterologists of Russia and the CIS countries, “gastroesophageal reflux disease (GERD). “is a chronic relapsing disease characterized by certain esophageal and extraesophageal clinical manifestations and various morphological changes in the mucous membrane of the esophagus due to retrograde reflux of gastric or gastrointestinal contents into it” [1].
The true prevalence of GERD in childhood is unknown. The frequency of detection of reflux esophagitis in children with diseases of the gastrointestinal tract ranges from 8.7 to 17% [2]. Data on the incidence of severe and complicated GERD in children are contradictory. This problem is practically not covered in the domestic literature; most publications on this topic belong to foreign authors [3].
The following factors and diseases are currently known to predispose to severe chronic GERD. - obesity, pathology of the nervous system, conditions after operations for atresia, achalasia of the esophagus and lung transplantation, congenital diseases of the esophagus, cystic fibrosis, hiatal hernia, family history of GERD, Barrett's esophagus/esophageal adenocarcinoma. These children require longer periods of therapy to achieve healing of the esophageal mucosa and maintain remission [4, 5 ] . Complications of GERD, such as strictures, esophageal ulcers and Barrett's esophagus, are observed with high frequency in children with conditions precipitating GERD [3, 4 ].
There are difficulties and limitations in determining management tactics for this category of patients due to their heterogeneity. There is no strict algorithm or clear recommendations for the treatment of children with an obviously severe, and in some situations complicated, course of GERD. In each specific case, it is necessary to be guided by the famous statement of Hippocrates: “It is necessary to treat not the disease, but the patient.”
Let us dwell in more detail on some conditions and diseases that provoke the development of severe GERD in childhood.
The high incidence and severe course of GERD in children with neurological diseases, including developmental delay, are described in the literature [3, 6]. In particular, children with cerebral palsy are at high risk for developing GERD [3, 7, 8]. Children with genetic Cornelia de Lange and Down syndromes are also predisposed to developing GERD [9].
The nature of the severe chronic course of GERD in children with pathology of the nervous system is multifactorial. Prolonged horizontal position, impaired swallowing, delayed evacuation of food from the stomach, constipation, obesity, skeletal abnormalities, muscle tone disorders and side effects of medications used contribute to a high incidence of reflux and slower esophageal clearance. In addition, the severity of GERD may be due to the insufficiency of protective antireflux mechanisms and a delay in diagnosis due to objective difficulties in examination and assessment of symptoms. Diagnosis of GERD in children with neurological disorders is complicated by difficulties in communicating with patients and the presence of atypical symptoms (anxiety, dystonia, seizures, etc.) [10]. The examination of these children should be aimed not so much at confirming GERD, but primarily at excluding other diagnoses that are accompanied by similar symptoms. According to indications, X-ray contrast studies, endoscopy, pH measurements, impedance measurements, screening for metabolic disorders and drug toxicity are performed.
Treatment of children with pathology of the nervous system and concomitant GERD should include measures to change lifestyle and nutrition, which will depend on the patient’s existing risk factors. Thus, one study showed an improvement in the symptoms of GERD, resistant to therapy, with the use of an amino acid mixture. But this work did not make a differential diagnosis between GERD and eosinophilic esophagitis [11]. Effective treatment options for this group of patients may include changes in food consistency, volume, and frequency of intake, postural therapy, correction of muscle tone, and biofeedback. Antisecretory therapy is also prescribed in the optimal regimen and doses according to international recommendations [3]. These recommendations outline the following main points regarding the treatment of GERD [3]:
- Lifestyle changes and diet have clear benefits in children with GERD.
- Proton pump inhibitors (PPIs). - the most effective class of drugs for suppressing secretion, superior to H2 blockers in eliminating symptoms and treating esophagitis.
- For long-term therapy, the minimum effective dose of PPI should be used.
- In most cases, taking a PPI once a day is sufficient.
- Continuous antacid therapy is not recommended; PPIs or H2 blockers are more effective and safe.
Treatment with proton pump inhibitors in children with neurological disorders can be used effectively long-term on demand and to maintain remission in esophagitis [3, 4].
If conservative measures are ineffective, the issue of surgical treatment is considered. Gastrostomy placement, either open or laparoscopic, has been found to increase the subsequent risk of developing GERD [3, 12]. Other authors found that, in contrast to children operated on with an open approach, in children with laparoscopic and percutaneous gastrostomy, GERD developed less frequently in the postoperative period [3, 13].
Given the mortality and high failure rates of surgical treatments for GERD, patients who have responded well to conservative therapy should not be referred for surgery. In addition, data on the benefits and risks of antireflux surgery in children with neurological impairment and persistent symptoms of GERD, even with supportive conservative treatment, are unclear and contradictory [6, 14]. Although surgical treatment is preferred in patients with respiratory complications of GERD, the effectiveness of this approach is difficult to establish.
The available literature provides the results of retrospective studies regarding surgical treatment of children with GERD. Unfortunately, they lack data on the details of the diagnosis of GERD and previous drug treatment, which undoubtedly complicates the determination of indications for surgical treatment and assessment of surgical outcomes [15, 16]. Many studies do not contain the results of a complete comprehensive examination of patients after surgery, including pH-metry, impedance measurements, and endoscopy [5, 17, 18]. However, it was found that in children with neurological diseases operated on for GERD, complications were observed more than 2 times more often, mortality was 3 times higher, and the need for repeated surgery arose 4 times more often compared with children without neurological diseases. problems [3]. As a result of a 3.5-year postoperative follow-up, the authors showed that more than a third of children with neurological disorders develop serious complications or die within a month after antireflux surgery [3]. In a quarter of patients, antireflux surgery is ineffective, and in 71% of children there is a recurrence of one or more symptoms within 1 year after surgery.
Obesity and rapid weight gain have been shown to be associated with a high incidence and severity of GERD, as well as the detection of Barrett's esophagus and esophageal adenocarcinoma [19, 20].
Esophageal atresia is the most common malformation of the gastrointestinal tract during the newborn period, its incidence is 1 case in 3000 newborns. Dysmotility of the esophagus, its shortening as a result of surgery, and the frequent combination of esophageal atresia with hiatal hernia predispose to chronic and severe GERD [21, 22]. Among children operated on for esophageal atresia, 50-95% of patients had clinical manifestations characteristic of GERD, including dysphagia and respiratory symptoms [3 , 22]. Long-term observation of 272 children with esophageal atresia did not reveal a single case of esophageal cancer [23]. However, the authors of this study recommend that patients with esophageal atresia undergo regular endoscopic examination to screen for Barrett's esophagus and esophageal cancer. In the era before the use of proton pump inhibitors, antireflux surgery was thought to be effective, but it has now been shown that in children undergoing surgery for esophageal atresia, fundoplication often does not produce the desired results. Antisecretory therapy with proton pump inhibitors is highly effective in patients with operated esophageal atresia and GERD [4 ] .
Patients with esophageal achalasia after dilatation or myotomy are also at risk for developing chronic GERD, esophagitis, and Barrett's esophagus [3, 24]. The benefits of performing antireflux therapy at the time of myotomy are controversial [25]. All patients after surgery for esophageal atresia and achalasia should be monitored for possible complications of GERD, as should patients after antireflux surgery [24]. ].
A high incidence of GERD and its complications is observed in patients with various chronic pathologies of the respiratory tract, including bronchopulmonary dysplasia, idiopathic interstitial fibrosis, and most often. — cystic fibrosis [3]. In one study, 27% of cystic fibrosis patients under 5 years of age had symptoms consistent with reflux (heartburn, regurgitation) compared with 6% of their siblings [3]. Using pH-metry, pathological reflux was detected more often, which indicates the asymptomatic course of the disease in the majority of patients with cystic fibrosis [3]. The high frequency of detection of esophagitis and the potential risk of developing adenocarcinoma justifies the prescription of aggressive therapy for this group of patients. A retrospective review of the outcomes of fundoplication in patients with cystic fibrosis showed that complications requiring refundoplication occurred in 12% of children, GERD symptoms returned in 48% of patients, and only 28% of children managed to do without drug treatment [26]. Conflicting data exist regarding the association of bronchopulmonary dysplasia and GERD [3].
According to foreign authors, therapy for GERD is often prescribed to premature infants [27, 28]. In a recent study, a quarter of infants with birth weight <1000 g received antireflux therapy after discharge [28]. However, the true incidence of peptic esophagitis or pulmonary disease due to GERD in prematurity is unknown. In preterm infants, physiological protective antireflux mechanisms are generally intact [29]. Although some authors have suggested a connection between episodes of apnea, bradycardia in prematurity and reflux [30], most studies have not established a relationship between reflux and pathological apnea in preterm infants [32, 33]. One retrospective study showed that the incidence of GER. - associated apnea decreases after the initiation of gastrojejunal tube feeding, indicating that GER may still be a cause of apnea [33]. Other authors have found that a variety of symptoms (respiratory, sensory and motor) in children with chronic lung disease were associated with reflux into the proximal esophagus, although the clinical significance of these symptoms remains unclear [29].
Although episodes of reflux are common in newborns with bronchopulmonary dysplasia, there is currently no evidence that GERD treatment affects disease progression or outcome [3, 30].
One study found an 11-fold increase in the diagnosis of esophageal adenocarcinoma in adult patients born preterm or with low birth weight [34]. However, a subsequent case-control study did not find a strong correlation between the risk of esophageal adenocarcinoma and birth weight [35].
Thus, despite the developed algorithms for the diagnosis and treatment of gastroesophageal reflux disease in children, there is a group of patients predisposed to a severe course of the disease, requiring an individual approach and long-term observation due to the risk of subsequently developing such serious complications as Barrett's esophagus and esophageal adenocarcinoma. In the treatment of these patients, preference is given to conservative methods of therapy. Surgical treatment with antireflux operations is a “therapy of despair” and does not always solve the problem of severe complicated gastroesophageal reflux disease.
LITERATURE
1. Privorotsky V.F., Luppova N.E., Belmer S.V. and others. Working protocol for the diagnosis and treatment of gastroesophageal reflux disease in children // Children's Hospital. - 2014. - No. 1. - P. 54-61.
2. Privorotsky V.F., Luppova N.E. Draft working protocol for the diagnosis and treatment of gastroesophageal reflux disease. Materials of the XII Congress of Pediatric Gastroenterologists of Russia. - M., 2005.
3. Vandenplas Y., Rudolph CD, Di Lorenzo C. et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) // Journal of Pediatric Gastroenterology and Nutrition. - 2009. - Vol. 49. - R. 498-547.
4. Hassall E., Kerr W., El-Sera HB. Characteristics of children receiving proton pump inhibitors continuously for up to 11 years duration // J Pediatr. - 2007. - Vol. 150. - R. 262-7.
5. Hassall E. Outcomes of fundoplication: causes for concern, newer options // Arch Dis Child. - 2005. - Vol. 90. - R. 1047-52.
6. Goldin AB, Sawin R., Seidel KD et al. Do antireflux operations decrease the rate of reflux-related hospitalizations in children? // Pediatrics. - 2006. - Vol. 118. - R. 2326-33.
7. Bozkurt M., Tutuncuoglu S., Serdaroglu G. et al. Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride // J Child Neurol. - 2004. - Vol. 19. - R. 973-6.
8. Pensabene L., Miele E., Giudice ED et al. Mechanisms of gastroesophageal reflux in children with sequelae of birth asphyxia // Brain Dev. - 2008. - Vol. 30. - R. 563-71.
9. Luzzani S., Macchini F., Valade A. et al. Gastroesophageal reflux and Cornelia de Lange syndrome: typical and atypical symptoms // Am J Med Genet. - 2003. - Vol. 119. - R. 283-7.
10. Gossler A., Schalamon J., Huber-Zeyringer A. et al. Gastroesophageal reflux and behavior in neurologically impaired children // J Pediatr Surg. - 2007. - Vol. 42. - R. 1486-90.
11. Miele E., Staiano A., Tozzi A. et al. Clinical response to aminoacid-based formula in neurologically impaired children with refractory esophagitis // J Pediatr Gastroenterol Nutr. - 2002. - Vol. 35. - R. 314-9.
12. Sleigh G., Brocklehurst P. Gastrostomy feeding in cerebral palsy: a systematic review // Arch Dis Child. - 2004. - Vol. 89. - R. 534-9.
13. Catto-Smith AG, Jimenez S. Morbidity and mortality after percutaneous endoscopic gastrostomy in children with neurological disability // J Gastroenterol Hepatol. - 2006. - Vol. 21. - R. 734-8.
14. Vernon-Roberts A., Sullivan PB Fundoplication versus post-operative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy // Cochrane Database Syst Rev. - 2007. - CD006151.
15. Gilger MA, Yeh C, Chiang J et al. Outcomes of surgical fundoplication in children // Clin Gastroenterol Hepatol. - 2004. - Vol. 2. - R. 978-84.
16. Mathei J., Coosemans W., Nafteux P. et al. Laparoscopic Nissen fundoplication in infants and children: analysis of 106 consecutive patients with special emphasis in neurologically impaired vs. neurologically normal patients // Surg Endosc. - 2008. - Vol. 22. - R. 1054-9.
17. Lobe TE The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children // Surg Endosc. - 2007. - Vol. 21. - R. 167-74.
18. Vakil N. Review article: the role of surgery in gastroesophageal reflux disease // Aliment Pharmacol Ther. - 2007. - Vol. 25. - R. 1365-72.
19. El-Serag H. Role of obesity in GORD-related disorders // Gut. - 2008. - Vol. 57. - R. 281-4.
20. Gerson LB A little weight gain, how much gastroesophageal reflux disease? // Gastroenterology. - 2006. - Vol. 131. - R. 1644-6.
21. Koivusalo A., Pakarinen MP, Rintala RJ The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula-a systematic clinical, pH-metric, and endoscopic follow-up study // J Pediatr Surg. - 2007. - Vol. 42. - R. 370-4.
22. Taylor AC, Breen KJ, Auldist A. et al. Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: long-term follow-up study // Clin Gastroenterol Hepatol. - 2007. - Vol. 5. - R. 702-6.
23. Sistonen SJ, Koivusalo A, Lindahl H et al. Cancer after repair of esophageal atresia: population-based long-term follow-up // J Pediatr Surg. - 2008. - Vol. 43. - R. 602-5
24. Leeuwenburgh I., Van Dekken H., Scholten P. et al. Oesophagitis is common in patients with achalasia after pneumatic dilatation // Aliment Pharmacol Ther. - 2006. - Vol. 23. - R. 1197-203.
25. Roberts KE, Duffy AJ, Bell RL Controversies in the treatment of gastroesophageal reflux and achalasia // World J Gastroenterol. - 2006. - Vol. 12. - R. 3155-61.
26. Boesch RP, Acton JD Outcomes of fundoplication in children with cystic fibrosis // J Pediatr Surg. - 2007. - Vol. 42. - R. 1341-4.
27. Jadcherla S., Rudolph C. Gastroesophageal reflux in the preterm neonate // Neoreviews. - 2005. - Vol. 6. - R. 87-98.
28. Malcolm WF, Gantz M, Martin RJ et al. Use of medications for gastroesophageal reflux at discharge among extremely low birth weight infants // Pediatrics. - 2008. - Vol. 121. - R. 22-7.
29. Jadcherla SR, Gupta A, Fernandez S et al. Spatiotemporal characteristics of acid refluxate and relationship to symptoms in premature and term infants with chronic lung disease. // Am J Gastroenterol. - 2008. - Vol. 103. - R. 720-8.
30. Magista AM, Indrio F., Baldassarre M. et al. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity // Dig Liver Dis. - 2007. - Vol. 39. - R. 216-21.
31. Lopez-Alonso M, Moya MJ, Cabo JA et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux // Pediatrics. - 2006. - Vol. 118. - R. 299-308.
32. Finer NN, Higgins R, Kattwinkel J et al. Summary proceedings from the apnea-of-prematurity group // Pediatrics. - 2006. - Vol. 117. - R. 47-51.
33. Misra S., Macwan K., Albert V. Transpyloric feeding in gastro-esophageal-reflux-associated apnea in premature infants // Acta Paediatr. - 2007. - Vol. 96. - R. 1426-9.
34. Kaijser M., Akre O., Cnattingius S. et al. Preterm birth, lowbirth weight, and risk for esophageal adenocarcinoma // Gastroenterology. - 2005. - Vol. 128. - R. 607-9.
35. Akre O., Forssell L., Kaijser M. et al. Perinatal risk factors for cancer of the esophagus and gastric cardia: a nested case-control study // Cancer Epidemiol Biomarkers Prev. - 2006. - Vol. 15. - R. 867-71.
REFERENCES
1. Privorotskiy VF, Luppova NE, Bel'mer SV et al. The working protocol of diagnosis and treatment of gastroesophageal reflux disease in children. Detskaya bol'nitsa, 2014, no. 1, pp. 54-61 (in Russ.).
2. Privorotskiy VF, Luppova NE Proekt rabochego protokola diagnostiki i lecheniya gastroezofageal'noy reflyuksnoy bolezni. Materialy XII Kongressa detskikh gastroenterologov Rossii [The project is a working protocol of diagnosis and treatment of gastroesophageal reflux disease. Materials XII Congress of Russian pediatric gastroenterologists]. Moscow, 2005.
3. Vandenplas Y., Rudolph CD, Di Lorenzo C. et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition, 2009, vol. 49, rr. 498-547.
4. Hassall E., Kerr W., El-Sera HB. Characteristics of children receiving proton pump inhibitors continuously for up to 11 years duration. J Pediatr., 2007, vol. 150, rr. 262-7.
5. Hassall E. Outcomes of fundoplication: causes for concern, newer options. Arch Dis Child., 2005, vol. 90, rr. 1047-52.
6. Goldin AB, Sawin R., Seidel KD et al. Do antireflux operations decrease the rate of reflux-related hospitalizations in children? Pediatrics, 2006, vol. 118, rr. 2326-33.
7. Bozkurt M., Tutuncuoglu S., Serdaroglu G. et al. Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride. J Child Neurol., 2004, vol. 19, rr. 973-6.
8. Pensabene L., Miele E., Giudice ED et al. Mechanisms of gastroesophageal reflux in children with sequelae of birth asphyxia. Brain Dev., 2008, vol. 30, rr. 563-71.
9. Luzzani S., Macchini F., Valade A. et al. Gastroesophageal reflux and Cornelia de Lange syndrome: typical and atypical symptoms. Am J Med Genet., 2003, vol. 119, rr. 283-7.
10. Gossler A., Schalamon J., Huber-Zeyringer A. et al. Gastroesophageal reflux and behavior in neurologically impaired children. J Pediatr Surg., 2007, vol. 42, rr. 1486-90.
11. Miele E., Staiano A., Tozzi A. et al. Clinical response to aminoacid-based formula in neurologically impaired children with refractory esophagitis. J Pediatr Gastroenterol Nutr., 2002, vol. 35, rr. 314-9.
12. Sleigh G., Brocklehurst P. Gastrostomy feeding in cerebral palsy: a systematic review. Arch Dis Child., 2004, vol. 89, rr. 534-9.
13. Catto-Smith AG, Jimenez S. Morbidity and mortality after percutaneous endoscopic gastrostomy in children with neurological disability. J Gastroenterol Hepatol., 2006, vol. 21, rr. 734-8.
14. Vernon-Roberts A., Sullivan PB Fundoplication versus post-operative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy. Cochrane Database Syst Rev., 2007. CD006151.
15. Gilger MA, Yeh C, Chiang J et al. Outcomes of surgical fundoplication in children. Clin Gastroenterol Hepatol., 2004, vol. 2, rr. 978-84.
16. Mathei J., Coosemans W., Nafteux P. et al. Laparoscopic Nissen fundoplication in infants and children: analysis of 106 consecutive patients with special emphasis in neurologically impaired vs. neurologically normal patients. Surg Endosc., 2008, vol. 22, rr. 1054-9.
17. Lobe TE The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children. Surg Endosc., 2007, vol. 21, rr. 167-74.
18. Vakil N. Review article: the role of surgery in gastroesophageal reflux disease. Aliment Pharmacol Ther., 2007, vol. 25, rr. 1365-72.
19. El-Serag H. Role of obesity in GORD-related disorders. Gut, 2008, vol. 57, rr. 281-4. 20. Gerson LB A little weight gain, how much gastroesophageal reflux disease? Gastroenterology, 2006, vol. 131, rr. 1644-6.
21. Koivusalo A., Pakarinen MP, Rintala RJ The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula—a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg., 2007, vol. 42, rr. 370-4.
22. Taylor AC, Breen KJ, Auldist A. et al. Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: long-term follow-up study. Clin Gastroenterol Hepatol., 2007, vol. 5, rr. 702-6.
23. Sistonen SJ, Koivusalo A, Lindahl H et al. Cancer after repair of esophageal atresia: population-based long-term follow-up. J Pediatr Surg., 2008, vol. 43, rr. 602-5
24. Leeuwenburgh I., Van Dekken H., Scholten P. et al. Oesophagitis is common in patients with achalasia after pneumatic dilatation. Aliment Pharmacol Ther., 2006, vol. 23, rr. 1197-203.
25. Roberts KE, Duffy AJ, Bell RL Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol., 2006, vol. 12, rr. 3155-61.
26. Boesch RP, Acton JD Outcomes of fundoplication in children with cystic fibrosis. J Pediatr Surg., 2007, vol. 42, rr. 1341-4.
27. Jadcherla S., Rudolph C. Gastroesophageal reflux in the preterm neonate. Neoreviews, 2005, vol. 6, rr. 87-98.
28. Malcolm WF, Gantz M, Martin RJ et al. Use of medications for gastroesophageal reflux at discharge among extremely low birth weight infants. Pediatrics, 2008, vol. 121, rr. 22-7.
29. Jadcherla SR, Gupta A, Fernandez S et al. Spatiotemporal characteristics of acid refluxate and relationship to symptoms in premature and term infants with chronic lung disease. Am J Gastroenterol., 2008, vol. 103, rr. 720-8.
30. Magista AM, Indrio F., Baldassarre M. et al. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity. Dig Liver Dis., 2007, vol. 39, rr. 216-21.
31. Lopez-Alonso M, Moya MJ, Cabo JA et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics, 2006, vol. 118, rr. 299-308.
32. Finer NN, Higgins R, Kattwinkel J et al. Summary proceedings from the apnea-of-prematurity group. Pediatrics, 2006, vol. 117, rr. 47-51.
33. Misra S., Macwan K., Albert V. Transpyloric feeding in gastro-esophageal-reflux-associated apnea in premature infants. Acta Paediatr., 2007, vol. 96, rr. 1426-9.
34. Kaijser M., Akre O., Cnattingius S. et al. Preterm birth, lowbirth weight, and risk for esophageal adenocarcinoma. Gastroenterology, 2005, vol. 128, rr. 607-9.
35. Akre O., Forssell L., Kaijser M. et al. Perinatal risk factors for cancer of the esophagus and gastric cardia: a nested case-control study. Cancer Epidemiol Biomarkers Prev., 2006, vol. 15, rr. 867-71.
