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Intervention Review

Fundoplication versus post-operative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy

  1. Angharad Vernon-Roberts*,
  2. Peter B Sullivan

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 10 AUG 2009

DOI: 10.1002/14651858.CD006151.pub2


How to Cite

Vernon-Roberts A, Sullivan PB. Fundoplication versus post-operative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006151. DOI: 10.1002/14651858.CD006151.pub2.

Author Information

  1. Oxford Children's Hospital, Oxford University Department of Paediatrics, Oxford, UK

*Angharad Vernon-Roberts, Oxford University Department of Paediatrics, Oxford Children's Hospital, Level 2, Headington, Oxford, OX3 9DU, UK. Angharad.Vernon-Roberts@paediatrics.ox.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 24 JAN 2007

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This is not the most recent version of the article. View current version (28 AUG 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Children with neurological impairments (NI) frequently experience feeding difficulties which can lead to malnutrition and growth failure. Gastrostomy feeding is now the preferred method of providing nutritional support to children with NI who are unable to feed adequately by mouth. Complications may arise as a result of gastrostomy placement and the development or worsening of gastro-oesophageal reflux (GOR) has been widely reported. This has led to the frequent use of surgical anti-reflux treatment in the form of a fundoplication, or other Anti-Reflux Procedures. Fundoplication is associated with a high recurrence rate, surgical failure and significant morbidity and mortality.

Since Proton Pump Inhibitors (PPIs) were introduced in the 1990s they have come to play a larger part in the medical management of GOR in children with NI. Uncontrolled studies suggest that PPIs may be a safe, appropriate treatment for GOR. Other agents currently used include milk thickeners, acid suppression drugs, acid buffering agents, gut motility stimulants and sodium alginate preparations.

There are risks and benefits associated with both surgical and medical interventions and further comparison is necessary to determine the optimal treatment choice.

Objectives

To compare the effectiveness of anti-reflux surgery and anti-reflux medications for children with NI and GOR who are undergoing placement of a gastrostomy feeding tube.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) up to Issue 2, 2009, MEDLINE (1966 to June 2009), EMBASE (1980 to week 23, 2009), CINAHL (1982 -to Dec 2008), LILACS (1982 to June 2009), ISI Web of Science (1970 to June 2009) and the Child Health Library (searched June 2009). We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses. Specialists in the medical and industry setting were contacted for knowledge of completed or ongoing trials.

Selection criteria

We sought to include only randomised controlled trials that recruited children up to the age of 18 years with NI and GOR who were undergoing gastrostomy tube insertion.

Data collection and analysis

Review authors worked independently to select trials; none were identified.

Main results

No trials were identified that satisfied the criteria for this review.

Authors' conclusions

There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus anti-reflux medications for gastro-oesophageal-reflux in the child with neurological impairment who is undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Is surgery or medical treatment more effective in treating acid reflux in brain damaged children having a feeding tube inserted

Children with cerebral palsy often have oral motor impairment and need help with eating and drinking. Frequently this entails surgery to place a feeding tube (gastrostomy) directly into their stomach. They may also be found to have gastro-oesophageal reflux (where stomach acid flows back up into the oesophagus) which can be made worse by gastrostomy surgery. Reflux can be treated either with additional surgery at the same time as the gastrostomy (a fundoplication) or with anti-reflux medications. This review was carried out to determine which was the safest and most effective form of treatment. We found no randomised controlled trials that provided scientific evidence on which to base a conclusion, which highlighted the need for a trial comparing the two interventions.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用胃底折疊術 (Fundoplication) 或術後藥物治療經胃造口手術 (gastrostomy) 、有神經損傷病童的胃食道逆流

有神經損傷 (NI) 的兒童通常會有進食困難,這可能引起營養不良和成長遲緩.胃造口手術餵食法是現行較好的方式,輔助營養提供,幫助無法經口攝取足夠食物的NI孩童.胃造口手術可能引起併發症,也有很多關於胃造口手術使胃食道逆流惡化的相關報告.因此常使用胃底折疊術或其他抗逆流療程治療.胃底折疊術 有高復發率,手術失敗率與嚴重發病率和死亡.自從90年代開始使用質子幫浦抑制劑 (PPIs) 後,大部分醫療上都使用PPI治療有神經損傷病童的胃食道逆流.沒有對照組的試驗顯示用PPI治療GOR是安全適當的.最近有使用包含牛奶增稠劑,制酸劑,酸緩衝劑,腸道蠕動興奮劑,海藻酸鈉 等其他介質.不論手術或藥物治療都有優點和風險,需要更多研究比較何者為最好的治療方法.

目標

比較抗逆流手術和抗逆流藥物,對NI且裝有胃造口餵食管孩童的胃食道逆流 (GOR) 狀況之療效

搜尋策略

搜尋 Cochrane Central Register of Controlled Trials (CENTRAL) up to Issue 2, 2006, MEDLINE (1966 to June 2006), EMBASE (1980 to week 33, 2006), CINAHL (1982 to May, week 4, 2006), LILACS (1982 to June 2006), ISI Web of Science (1970 to June 2006) and the Child Health Library (searched June 2006). 也線上搜尋有登記的試驗,藥物期刊,會議資料,學位論文和論文.連絡醫界和產業界專家以得到完成或進行中試驗的資料.

選擇標準

只有隨機對照試驗,對象為18歲以下有NI和GOR且裝有胃造口餵食管的兒童.

資料收集與分析

兩個檢閱者獨立檢閱試驗,擷取資料和評定試驗品質.

主要結論

沒有試驗符合納入條件.

作者結論

對象為裝有胃造口餵食管NI孩童時,仍不確定胃底折疊術或抗逆流藥物,何者才是最佳胃食道逆流治療.需要實際科學證據以提供兩種治療的風險或益處.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

腦性麻痺 (cerebral palsy) 兒童常有口腔運動損傷,進食和飲水時都需要幫助.通常採用手術直接於胃中置入餵食管.病童也可能有胃食道逆流 (胃酸流回食道), 胃造口手術會使胃食道逆流狀況惡化.可於胃造口手術時同時進行胃底折疊術,或用抗逆流藥物治療逆流.本回顧目的為確認哪種是最安全有效的治療,但沒有可供參佐的隨機對照試驗.目前非常需要比較這兩種治療的試驗.