Gastro-oesophageal reflux in children with cerebral palsy after percutaneous endoscopic gastrostomy: Any predictors?

Abstract 

Background and study aims

Gastro-oesophageal reflux (GER) is common in children with cerebral palsy (CP). Such children often require percutaneous endoscopic gastrostomy (PEG) to alleviate feeding difficulty, yet GER may get worse following PEG. The aim of this study was to assess whether abnormal pH study and oesophagitis or delayed gastric emptying can predict worsening of GER after PEG.

Patients and methods

A chart review was conducted of 25 children with cerebral palsy (CP) who had PEG performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between September 2001 and May 2007. Data collected included pre-procedure 24-h pH study, gastric emptying nuclear scan, and histopathology of the oesophageal biopsy obtained at the time of PEG placement. Clinical symptoms of GER and the need for fundoplication were also recorded.

Results

Twenty-five patients with severe CP (21 male; mean age 6.0±5.3 years) were included. Thirteen (52%) had abnormal pH study. Six (24%) had delayed gastric emptying, and 10 (40%) had histological oesophagitis. Following PEG, 16 (64%) had persistent vomiting. Twelve were controlled with medical treatment. Four (16%) required fundoplication. There was no relation between abnormal pH study, delayed gastric emptying or oesophagitis and the development of persistent vomiting after PEG. There was no statistically significant difference between patients who required fundoplication and the remaining patients in either pH or gastric emptying study.

Conclusion

An abnormal pH study and oesophagitis or the presence of delayed gastric emptying before PEG placement in children with CP did not predict worsening of GER or the need for fundoplication after PEG.

Keywords: Gastrostomy, Gastresophageal reflux, Gastric emptying, Cerebral palsy, Saudi Arabia