GER and aspiration in patients fed via a gastrostomy tube may be caused by relaxation of the lower esophageal sphincter (LES) secondary to gastric distension caused by rapid intragastric bolus feeding. When feeding rate was slowed, LES pressure did not diminish to incompetent levels of 2 mmHg. In general, prospective studies have shown reduction of vomiting, pneumonia, restlessness and pain in more then 60% of patients. After PEG placement, 24-h pH monitoring improved, and histological reflux esophagitis normalized in these children. Anti-reflux surgery for PEG placement considerably increased the complications and failed to improve symptomatology. Thus, there does not seem to be a place for anti-reflux surgery unless symptoms progress after PEG placement, in spite of concomitant treatment with proton pump inhibitors.
The improvement in nutritional status obtained through PEG feeding induced further improvement in reflux, as judged by 24-h pH studies, suggesting a relation between malnourishment and reflux symptoms.25
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