Abstract
We compared medical and surgical treatment of GER in 31 severely retarded children (mean age 15.9 yr; IQ<20) to define relative risk and effectiveness of each method and develop treatment guidelines for this special patient group. At diagnosis all 31 were treated ≥ 8 wks with antacids, small frequent feedings, elevation of head and in 2 bethanechol. In 8 “responders” (26%) symptoms cleared completely(4) or partially(4). Of 23 medical failures, 14 underwent Nissen fundoplication and gastrostomy. In 9 medical “failures” surgery was refused and medical therapy was continued. Results are below.
Perioperative complications in 6 pts were esophageal perforation-2, gas bloat-2, herniated plication-2, intestinal obstruction-2, infection-2, gastric leak-1, esophageal stricture-1. Two surgical patients died of aspiration 40 & 60 days postop. Two medical failures also died of aspiration.
Conclusions: Medical therapy of GER is less effective in retarded than normal children. Surgery carries high risk but provides good symptom control in medical failures. Mortality in medically uncontrolled patients is as great as that of surgical patients.
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Sondheimer, J., Wilkinson, J., Dudgeon, D. et al. 642 MEDICAL VS SURGICAL MANAGEMENT OF GASTROESOPHAGEAL (GER) IN THE SEVERELY MENTALLY RETARDED. Pediatr Res 15 (Suppl 4), 547 (1981). https://doi.org/10.1203/00006450-198104001-00655
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DOI: https://doi.org/10.1203/00006450-198104001-00655
