GASTROESOPHAGEAL REFLUX AND FEEDING PROBLEMS AFTER GASTROSTOMY IN CHILDREN WITH SEVERE NEUROLOGICAL IMPAIRMENT

This study evaluated the effect of percutaneous endoscopic gastrostomy (PEG) on the feeding problems and gastro-oesophageal reflux (GOR) of 30 consecutive children with severe neurological impairment who had PE G between October 1990 and March 1993. Evaluation was by questionnaire , clinical history, examination, 24-hour oesophageal pH monitoring and endoscopy. Gastrostomy placement significantly reduced feeding time, feed-related choking episodes and frequency of chest infections. Famil y stress was significantly reduced in two-thirds of cases. Significant weight-gain occurred. The clinical severity of GOR was significantly increased in eight patients and fundoplication was required in five. 2 4-hour oesophageal pH measurements before PEG did not reliably predict subsequently increased GOR. Seven patients died, but their deaths wer e apparently unrelated to GOR. PEG effectively provides nutrition, imp roves feed-related stresses, but may exacerbate GOR.