![]() One year post operatively, she continues to be asymptomatic and has regained her weight. ![]() The patient underwent Nissen fundoplication with complete resolution of her chronic reflux symptoms. Due to the refractory GERD and normal repeat manometry study, the patient was referred for laparoscopic Nissan fundoplication. A manometry study was repeated in our institution, which revealed normal peristalsis and a normal mean LES pressure of 21 mmHg. However, serologic workup for scleroderma was negative. An initial esophageal manometry study at an outside institution showed findings suggestive of scleroderma esophagus with a low LES pressure and aperistalsis. Impedance pH monitoring (on BID PPI) revealed 208 reflux events (normal <73) with evidence of proximal reflux as well. A BRAVO pH study revealed multiple episodes of acid reflux, while on high dose PPI. Upper endoscopy showed a small sliding hiatal hernia but was essentially normal. The patient reported worsening regurgitation with intermittent solid food dysphagia, significant nausea, abdominal pain and a 10 lb weight loss over a 3 month period. We present a case of a 26 year old female with CP who presented to our institution with a history of chronic GERD refractory to PPI's. Success of Nissen fundoplication in CP patients is often cited in the pediatric literature but limited data is available in the adult population. ![]() Though proton-pump inhibitors (PPI's) are effective, a percentage of CP patients do not respond to medical management. Diagnosis may be difficult in CP patients due to atypical presentations such as frequent pulmonary infections, dental erosions, rumination and hematemesis. The prevalence is about 50% in those with an IQ <50, with about 70% having endoscopic evidence of reflux esophagitis. Purpose: Gastroesophageal reflux disease (GERD) is a frequently occurring problem in patients with Cerebral Palsy (CP), often diagnosed at an advanced stage.
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