Surgery: A treatment option?

There is a great deal of confusion about the use of Gastroesophageal Reflux Disease (GERD) surgery for infants and children and the role of surgery in treatment. I am beginning a series of blogs about all aspects of surgery in the treatment of GERD.

The vast majority of infants and children with GERD respond positively to medical treatment such as medication and a special diet. It is estimated that several million children in the United States have Gastroesophageal Reflux (GER) and GERD but only a few thousand surgical procedures for GERD are performed each year.

Over the years, new GERD medications have been developed and approved for use with infants and research has played a role in determining best practices for treating an infant or child with GERD. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has developed guidelines for the treatment of GERD in infants and children, providing physicians a standard course for care. There is more work to be done but a great deal of effort is directed at targeting best practices and proven treatments for GERD. It is likely that parents and doctors will work together to develop a treatment plan that eliminates the most worrisome symptoms. We know that most infants outgrow GER in the first year or two so treating pain offers comfort while waiting for the reflux to go away.

Only a much smaller group do not respond to the typical GERD treatments despite the best that medicine can offer or have medical complications that require surgery. Some infants have worrisome complications from GERD such as failure to thrive, aspiration, frequent pneumonia or apnea. If GERD is causing complications and has a negative impact on sleep, concentration, behavior and overall quality of life for the infant and family, this may be another indicator that surgery is warranted. An infant or child with severe erosion of the esophagus or ulcerations despite a high level of medical treatment or a child in need of a high dose of medication for long term treatment may be offered the option of surgery as an alternative to medical management. Parents and doctors will need to look at all of the symptoms and treatment options before considering surgery.

It is confusing and complex to decide if GERD surgery is an option for your child. I know because several years ago I was faced with the surgery decision for my daughter Rebecca. I will help you navigate the confusing and conflicting information and explain the surgery and surgical options available for infants and children.