Children with neurological impairment frequently exhibit clinical evidence of gastrointestinal dysmotility with oral motor impairment, gastro-oesophageal reflux (GOR), delayed gastric emptying, and constipation—for example, numerous reports have shown a high incidence of GOR (15–75%) in neurologically impaired children.1-3 Recent studies using electrogastrography have suggested that vomiting in children with central nervous system disease involving the brainstem nuclei or regions next to the area postrema (the “vomiting centre”) may result from a widespread disturbance of gastrointestinal motility (gastric dysrhythmia) or a persistent activation of the emetic reflex.4 Several reasons, in addition to the direct effect of central nervous system dysfunction on the lower oesophageal sphincter, have been proposed for the increased incidence of GOR in disabled children; these included hiatus hernia, adoption of a prolonged supine position, increased intra-abdominal pressure secondary to spasticity, scoliosis, or seizures.5 GOR is a significant clinical condition and is associated with reflux oesophagitis, recurrent vomiting, malnutrition, and recurrent aspiration pneumonia.

Feeding gastrostomy tubes are being used increasingly in this group of children in an attempt both to improve their nutritional status and to reduce the amount of time taken over feeding. Although long term follow up studies have shown that gastrostomy is an efficient and cost effective feeding technique,6 7 complications have been described in up to 26% of cases.8 One of the most significant complications is the development of GOR secondary to gastrostomy tube placement.9 10 Given that conventional medical treatment for GOR is often less effective in disabled children, this raises the question of whether a surgical antireflux procedure should routinely be performed at the same time as insertion of a gastrostomy tube.