Baerg, Shores, Fung, Yanni, Tagge, Deming Weight Gain in Infants With GERD Managed with Medical Therapy or Fundoplication. 3 minute Oral Poster presentation at the Canadian Association of Pediatric Surgeons. Toronto, Canada - August 2008. ( 8/2008 - 9/2010 )
Published Abstract:   The Role of Nissen Fundoplication in Promoting Weight Gain in Infants with GERD
Joanne E. Baerg, Douglas Deming. Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA; Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA.
BACKGROUND: Weight gain in infants with GERD has not been well-studied.
OBJECTIVE: To examine the role of Nissen fundoplication in promoting weight gain in infants with GERD.
DESIGN/METHODS: An IRB approved retrospective review was performed between January 2004 and December 2006 of infants under 6 months who underwent a 24-hour pH probe for GERD evaluation. Growth curves were evaluated at the time of study, 6 months later and at follow-up (2-5 years). Infants who maintained or exceeded their growth curve were considered to gain. Data were analyzed by chi-square and logistic regression. P-values <0.05 were considered significant.
RESULTS: 250 infants underwent a 24-hour pH-probe, 87(35%) had GERD. Thirty-one of 87(35.6%) underwent Nissen fundoplication and 56(64.4%) were treated with anti-reflux medications. Follow-up was complete for all 87. Nissen fundoplication was more likely to be carried out in infants with neurologic impairment (p=0.012), congenital heart disease (p=0.010), failure to thrive (p=0.015), inability to take food orally (p=0.001), vomiting(p=0.034), aspiration (p=0.030), and infants who were older than the mean age of the study group (0.027). Follow-up revealed similar proportions of infants with GERD who underwent Nissen fundoplication, 24/31 (77%) and infants treated with medications, 42/56 (75%), maintained their growth curves (p=0.801). Once infants were treated for GERD, logistic regression did not reveal a subgroup which gained better with either therapy: prematurity, OR 1.07 (95%CI 0.328-3.51), neurologic impairment OR .962 (95% CI 0.223-4.15), congenital heart disease, OR 1.49 (95% CI .257-8.64), inability to eat by mouth, OR 4.18 (95% CI .642-27.25), failure to thrive, OR .402(95% CI .089-1.806), vomiting, OR .927 (95% CI .219-3.92), and aspiration, OR 2.79 (95% CI .372-20.85). Recurrent GERD occurred in 5 Nissen patients (16%), but all maintained their growth curve and underwent re-do Nissen to control vomiting. Two of 56 treated with medications developed recurrent GERD (3.6%) at 7 and 11 months after pH probe and were losing weight. One underwent Nissen fundoplication and one underwent gastrojejunostomy placement.
CONCLUSIONS: Infants with GERD are more likely to undergo Nissen fundoplication if they have neurologic impairment, congenital heart disease, failure to thrive, vomit, cannot take food orally, aspirate or are older at the time of pH probe. Once treated, they gain weight in equal proportion to those treated with medications.