Gastroesophageal reflux in children with a congenital abdominal wall defect

Background/Purpose: Gastroesophageal reflux (GER) is considered common in p atients with congenital abdominal wall defects (CAWD). The aim of this stud y was to find out the frequency of GER in children with CAWD and, in partic ular, whether there is difference between patients with omphalocele and gas troschisis. Methods: Forty-two children, 19 with gastroschisis and 23 with omphalocele were examined for GER at the median age of 12.0 months (range, 1 to 132). E sophagoduodenoscopy with biopsies was performed on all patients. Eighteen p atients underwent 18-hour esophageal pH-monitoring. Results: GER was detected in 13 patients. All but one patient of the 13 had either macroscopic or microscopic esophagitis. One patient had pathologica l pH monitoring only. In children with omphalocele, the incidence of GER wa s 43% (10 of 231, whereas in gastroschisis patients the incidence was 16% ( 3 of 19), (P value, not significant). The median age of omphalocele patient s with GER was significantly lower (7 months) than the median age of those without GER (72 months; P = .01). In patients with gastroschisis age made n o difference. Six of 32 patients (19%) with primary fascial closure (small defects) had GER, whereas 7 of 10 patients (70%) in which primary fascial c losure was impossible (large defects) had GER (P < .01). Conclusion: CAWD patients, especially those with omphalocele and a large de fect have a high incidence of GER complicated by esophagitis during the fir st few years of life. J Pediatr Surg 34:1127-1129. Copyright (C) 1999 by W. B. Saunders Company.