A recent prospective observational study (M Aumar et al. J Pediatr 2018; 197: 116-20) examined the effect of percutaneous gastrostomy (PEG) tube placement on gastroesophageal reflux disease (GERD) over a 13 year period. This study included 326 patients, 56% who had neurologic impairment and had a median follow-up of 3.5 years (and in some cases follow-up to 15 years). GERD was defined as gastroesophageal reflux causing troublesome symptoms and/or complications. Routine pH studies or impedance were not performed.
- GERD was present in 242 of 326 patients at baseline (74%). GERD appeared in 11% of patients after PEG and was aggravated in 25% with preexisting GERD.
- Factors associated with worsening GERD were neurologic impairment and preexisting GERD.
- 53 patients (16%) required anti-reflux surgery with 22 (6%) in the year following PEG. The only factor identified with the need for surgery was neurologic impairment.
- At last followup, PEG remained in place in 133 children (41%), and had been removed in 99 (30%). 94 children (29%) were deceased, including 2 from an early procedure-related complication. In those who were deceased, the vast majority occurred related to evolution or complication of their underlying disease.
The authors note that studies have shown that PEG increases GERD, but “the majority of these studies were of low methodologic quality.”
My take: Routine antireflux surgery at the time of PEG placement is NOT needed in the majority of patients, even in those with baseline GERD. Less than 20% of patients with GERD required antireflux surgery.
Related blog posts:
- 2018 Pediatric Gastroesophageal Reflux Clinical Guidelines
- Fundoplication in children with neurologic impairment
- How Many Kids with Reflux have Reflux?
- Esophageal Diseases Special
- pH Probe Testing: Rumors of My Death are Premature
- Better to do a coin toss than an ENT exam to determine reflux
- PPI Webinar NAPSPGHAN
- Treating reflux does not help asthma | gutsandgrowth
- Salivary Pepsin Doesn’t Pass Muster for Reflux