Page 14 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Figure 2. The 13C gastric emptying breath test
Gastroesophageal reflux
A widely discussed possible complication of GP is the development or deterioration of GER. The majority of patients undergoing GP are neurologically impaired and therefore already at high risk of GER. 3,28 After GP, symptoms of GER are seen in 25–66% of patients. 5,29,30 In earlier days, a preventive fundoplication was sometimes performed simultaneously with GP in order to prevent future GER. 30 Also, some studies advocated the routine use of preoperative 24-h pH monitoring to predict postoperative GER. 30,31 However, only a few studies have been performed comparing pre- and postoperative values of esophageal pH measurement using 24-hour pH monitoring. While some studies suggest a worsening or development of esophageal acid exposure after operation 32,33, other studies show no change or decreased exposure. 31,34 Consequently, no consensus exists to date.
Diagnosing GER: Questionnaires
For symptom evaluation of GER in children, an age-specific reflux questionnaire has been developed: the infant Gastroesophageal reflux Symptom Questionnaire (GSQ). 35 Symptoms assessed are abdominal pain, burping or belching, choking when eating, difficulty swallowing, refusal to eat, vomiting and regurgitation.
Diagnosing GER: 24-hour MII-pH monitoring
Until recently, pH monitoring was considered the gold standard for GER measurement, measuring the frequency and duration of episodes of acidity in the esophagus. The development of multichannel intraluminal impedance (MII) greatly improved accuracy in diagnosing GER. 36-38 By adding electrical impedance to a pH-monitoring catheter at various levels, this technique detects changes in electrical impedance between two electrodes during the passage of a bolus. The main advantage of MII-pH over traditional pH monitoring is the ability to detect acid, weakly acidic and non-acid reflux episodes and to differentiate between liquid and gas movements within the esophageal lumen. 36,38,39
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