A comparison of medical and surgical treatment of gastroesophageal reflux in severely retarded children

Of 31 severely mentally and physically handicapped children with gastroesophageal reflux treated with a standard medical regimen, only eight (26%) had complete or partial therapeutic response. Fourteen of 23 medical failures underwent Nissen fundoplication with a good therapeutic response in 12. There were 12 intra- and postoperative complications in six surgical patients. Two late postoperative deaths from pulmonary aspiration occurred in the surgical group (14%), both of whom had abnormal deglutition preoperatively. In nine patients who failed on medical management but in whom surgery was not performed there was continuing morbidity from emesis (88%), anemia (44%), and pulmonary disease (33%), and two deaths (22%) resulting from pulmonary aspiration. We conclude that conventional medical therapy of GER is less effective in retarded than in normal infants and children, and that surgical treatment is associated with high operative risk but has an ultimately acceptable outcome. Continued medical therapy after initial failure to control symptoms is associated with significant morbidity and mortality.