Omeprazole maintenance therapy for gastroesophageal reflux disease after failure of fundoplication

Background: Recurrence of gastroesophageal reflux (GER) in children after f ailed fundoplication poses a therapeutic challenge. The authors report the experience with long-term omeprazole for children with severe GER after fai led fundoplication. Methods: The authors reviewed the charts of all children who were treated w ith omeprazole for GER subsequent to failed fundoplication from 1990 to 199 9. All underwent endoscopic and clinical assessment of the treatment at bas eline, at 3-5 months, at 6-9 months, and annually. Results: Eighteen children presented with GER, after a total of 27 fundopli cations. Ten had corrected esophageal atresia, 6 had neurologica impairment , and 2 had hiatal hernia. The mean age of presentation of children with re currence of GER was 7.8 years, and symptoms of GER occurred 4.9 years (rang e, 0.6-13) after last fundoplication. Fifteen patients had a mean follow-up of 4.4 years for omeprazole. Ten patients had grade III/IV esophagitis and 5 had grade II esophagitis at presentation after fundoplication. Marked im provement was noted in symptoms of GER and severity of esophagitis while ta king omeprazole. Remission of esophagitis was maintained while the patient was taking omeprazole and none had further surgery. There was no recurrence of peptic strictures in eight of nine children on omeprazole, after initia l esophageal dilatations. Except for benign gastric polyps in three patient s, no clinical adverse effects were observed. Conclusions: Omeprazole is an effective long-term drug for gastroesophageal reflux disease after failed fundoplication in children. Omeprazole was wel l-tolerated by all children and should be tried before subsequent surgical intervention.