When is surgery indicated in the treatment of pediatric gastroesophageal reflux disease (GERD)?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Answer

To summarize, surgical treatment of gastroesophageal reflux should be considered for the following patients:

  • Infants and children who have failed step-up therapy for gastroesophageal reflux (typically over 12 wk) and those who cannot be weaned off of acid-reducing medications should be considered for surgical treatment

  • Those with an atypical presentation, especially respiratory, whose symptoms are clearly associated with gastroesophageal reflux (eg, obstructive apnea temporally associated with reflux during pH monitoring) should be considered for surgical treatment; however, a period of medical therapy (including acid blockade) under close monitoring conditions should be attempted in many cases prior to recommending a surgical approach

  • Patients with complications of gastroesophageal reflux, such as aspiration, stricture of the esophagus, or Barrett esophagus, should be considered for surgical treatment

  • Patients with neurologic impairment that requires feeding gastrostomy who are found to have pathologic reflux and who remain medication dependent should be considered for surgery

  • Patients with chronic reflux and recurrence of anastomotic stricture after repair of esophageal atresia should be considered for surgical treatment


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