[Primary ad secondary gastro-esophageal reflux in pediatric age].
AIM: This study takes into consideration children traited for: a) "primary" gastro-esophageal reflux (GER); b) GER "secondary" to delayed gastric emptying; c) some congenital anomalies which can cause or favour GER in pediatric age. METHODS: During 2002, 21 infants or children operated on for "primary" or "secondary" GER and 62 patients operated on for esophageal atresia, diaphragmatic hernia or abdominal wall defect were followed-up to evaluate the frequency and the course of post-operative GER. RESULTS: Patients with "primary" GER had 14% relapses after partial or total fundoplication; all patients with "secondary" GER submitted to fundoplication, usually associated to pyloroplasty, had 0% relapses. One child, after Bianchi's operation, developed an erosive gastritis. Variable degrees of GER developed in 43% of patients operated on for esophageal atresia, in 25% for congenital diaphragmatic hernia and in 0% for abdominal wall defect. In 90% of GER occurred after treatment of esophageal atresia and in 100% of diaphragmatic hernia (predominantely "acquired") an exclusively medical therapy was successfully performed. CONCLUSION: The conclusion is drawn that: a) the relatively high percentage of relapses after fundoplication in "primary" GER may be related to an incorrect classification of a few number of cases ("secondary" GER considered--and treated--like "primary" GER in the '70s and '80s years?); b) fundoplication associated to a best gastric-emptying operation (pyloroplasty) may lead to excellent results in secondary GER; c) esophageal atresia and congenital diaphragmatic hernia (not including the abdominal wall defects) can cause GER in most cases responsive to simple medical therapy.