No medication is without side effects and contraindications. A database at http://www.rxlist.com/interact.htm can be used to research medications. It lists uses, contraindications, drug interactions, warnings, dosage, etc. When you look up medications on this list, click on the name of the drug rather than the link to patient information. That way you will get more data and be able to make an informed decision.
Several of the above mentioned drugs have important contraindications you should know about:
Cisapride has at this time been taken off the market due to causing heart problems. It is only available in "limited access" when other therapies have failed. Please note that cisapride is not to be taken with cimetidine. Cisapride also interacts with clonazepam which some children are taking for seizures. Cimetidine is not recommended for children unless the benefits outweigh the risks. One article states that metaclopramidean cause hearing loss. This article can be found at http://www.kfshrc.edu.sa/annals/152/9410... . Also, metaclopramide should not be used in children with epilepsy because it increases the frequency and severity of seizures.
Surgery
Fundoplication surgery is another way of handling reflux problems. In plain English, a fundoplication is a procedure where the upper portion of the stomach is wrapped around the lowest part of the esophagus and sutured together to constrict the opening. This allows food in, but not back out. The procedure can be done laproscopically to lessen danger of infection during surgery and decrease the length of the hospital stay. Fundoplication can be done with or without a gastrostomy tube, button, or other kind of tube.
There are different varieties of the surgery. Nissen fundoplication is a 360 degree wrap, also called a full wrap. Modified Rosseti and Modified Collis Nissen are other types of the 360 wrap. Toupet, Thal, and Boix Ochoa are partial wraps from 240-270 degrees.
Partial vs. Complete Fundoplication
Many studies have been done to assess the effectiveness of the full and partial fundoplication. Overall, studies indicate that a partial fundoplication is better than a full wrap. One problem has been that many parents have been unhappy with the results of the Nissen. With the Nissen there are more side effects than with a partial. Some side effects are gagging and retching which can cause the fundoplication to slip, and a higher occurrence of dysphagia.
There is even a site devoted to parents unhappy with the Nissen procedure. The site is called FUNDO. Some of the stories on this site are by parents who were assured that Nissen would cure the reflux and it did not. None of the stories on this site are of brain damaged children. Various studies show Nissen fundoplication to be 80-90% effective at a 10 year follow up. These studies were not done with HIE children. One study showed that the Nissen fails to control reflux in up to 25% of neurologically impaired children.
