[Results of surgical treatment of gastroesophageal reflux with respiratory manifestations].

Respiratory tract disease was the main indication for surgery in 45 out of the 102 children operated upon for GER in the last 7 years: twenty-four had recurrent bronchitis and pneumonia, 18 had bronchitis with constriction (true asthma in 10), 2 had unbearable cough and 1 apnoeic crises. All had been medically treated before without success. The diagnosis of GER has been accepted only in patients with abnormal results in three or more of the following tests: barium swallow, extended pH-metering, manometry, endoscopy-biopsy and gastro-oesophageal scintigraphy. Nissen fundoplication cured GER in all cases, and its effect on respiratory tract disease after an average follow-up of 17 months (range 6 to 48) was rather encouraging: twenty-six children cured (57%), 9 improved (21%) and 10 remained unchanged (22%). Failures were more frequent in children with bronchoconstriction (45%) and in those without prior digestive symptoms (36%). Surgery is probably indicated more often in the treatment of respiratory tract diseases associated with GER in children than it was previously thought, but indications remain difficult and the results are uncertain in children with either asthma or bronchoconstriction.