REFLUX

Reflux is a concern for parents after having a baby born with the birth defect esophageal atresia. This is also true for babies born with esophageal atresia (EA) with a tracheo-esophageal fistula (TEF).

Gastro-esophageal reflux (GER) seems to go hand in hand with these two birth defects and it is evident that gastro-esophageal reflux occurs after the connection of the two esophageal ends and with the creation of a new esophagus from another part of the body such as the colon, stomach or small intestine.

Another group of patients that are affected by gastro-esophageal reflux are babies born with GERD. They have no birth defect that can be seen but they have serious and life threatening episodes of vomiting, coughing, gagging and wrenching.

GERD is an acronym that stands for gastro-esophageal reflux disease. More babies are born with GERD than born with TEF/EA.

These babies born with GERD also suffer through the same problems and symptoms as babies born with TEF/EA or EA and need to be diagnosed and treated for reflux.

Babies with gastro-esophageal reflux disease (GERD) and either esophageal atresia (EA) with or without a tracheo-esophageal fistula (TEF) have the same symptoms such as cyanosis (skin turning blue) problems, choking spells, persistent coughing, gagging and vomiting spells that can last for minutes, hours or days. Some may even have spells of projectile vomiting that can last for minutes, hours or days.

Gastro-esophageal reflux is a serious and dangerous problem if not caught and treated. Gastro esophageal reflux causes many other problems such as asthma, bronchitis, pneumonia, high blood pressure, lung problems such as atelectasis which can all lead to death.

GERD was not understood in babies for years as it was not understood in adults. It was usually thought that adults who had reflux had a hiatal hernia which is when the stomach pushes up into the chest though the hole in the muscle called the diaphragm that separates the chest cavity from the abdominal cavity. The stomach does not belong in the chest and this caused many problems.

Reflux is when the food and liquid that is passed down into the stomach after swallowing occurs is pushed back up into the esophagus. The stomach has acid in it to help break down food and this mixture of food and acid is pushed back into the esophagus and can cause burning, gagging, choking spells as well as burns to the esophagus.

This burning or pain is called heartburn because patients complained of pain in the chest area where the heart is. The esophagus goes through an area of chest cavity where it is actually surrounded by blood vessels of the heart and this is why patients complain of chest pain because the esophagus is very near to the heart in its anatomical position and patients thought that it was their heart that was burning and or causing their pain.

Reflux is a serious condition and is most commonly treated with medication first. If medication does not stop the problem than a second way is to try and stop the reflux by an operation called a Nissen fundoplication. The name Nissen is the name of the surgeon who invented the operation and is an eponym for the operation. The medications that are used to prevent reflux have specific characteristics that act upon specific symptoms that lead to reflux. If the medicine can stop the symptoms it is to the benefit of the child. It is common for many different medications to be tried. Even if one medicine seems to be working well, it is not unusual for it to not work after a while and therefore another medication will be tried.

In some cases reflux is so serious that medication does nothing and surgery is the only alternative. The operation that is done all over the world and is the most common and successful operation is the reflux operation called the Nissen Fundoplication.

The operation consists of wrapping or folding part of the stomach called the fundus around the esophagus 360 degrees tightly to prevent reflux from backing up the esophagus and causing all the symptoms such as burning, gagging, choking, wrenching and vomiting to name a few.

By wrapping or folding the fundus around the esophagus and sewing the two ends together the wrapping closes off the lower esophagus just enough by preventing food and acid from going backwards up into the esophagus. The esophagus can still work normally to let food and liquid pass down the esophagus into the stomach.

The wrapping is to prevent or stop the backflow or vomiting up of the contents of the stomach after eating. This is the most common and successful operation done for reflux in the world. There are many variations to this with the name of the procedure or operation named after the doctor who modified the operation by Dr. Nissen.

Some other names for reflux operations or fundoplications are the Rossetti fundoplication, Thal fundoplication, Belsey 4 fundoplication, Doer fundoplication, Boix-ochoia fundoplication which are all modifications of the Nissen. Some of the operations are incomplete wraps of the fundus around the esophagus. What this means is that instead of completely wrapping or folding the part of the stomach called the fundus completely around the esophagus the modifications are done by wrapping or folding the fundus around the esophagus only 270 degrees. There are other operations that wrap or fold the fundus 180 degrees. Most of these procedures are named after the doctor who first did the operation.

The operations can be repeated and the results are usually good. There are occasions when the wraps seem to come undone over and over and no one seems to know why.

Some of the procedures sew the fundus anterior (front) and others sew the fundus posterior (back). They all have good and bad results to them. Some prevent vomiting and hiccupping and for some reason on occasion they don't work at all. The wrapping or folding of the fundus becomes undone and the reflux starts again.

Reflux is first treated with the many different medication s and if the medications don't prevent the reflux than the next step is to consider one of the available types of surgery called the fundoplications. This is major surgery on the abdomen with a large incision and scarring after.

Since 1995 some doctors have been doing the fundoplication by laparoscopy which means they make small incisions in the abdomen and place long thin metal tubes inside the abdomen that have a light source to see what they are doing, and other tubes to sew and wrap and irrigate or flush out the abdomen and vacuum out the liquid inside. It is not a common operation but it is gaining more popularity as more surgeons become more familiar with this procedure and learn how to do it by going to training classes.

Here is a list of the most common medicines to treat reflux. Some are medicines you can go to a store and buy called over the counter medicine and others you need to go to a doctor and get a prescription for.