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Aim of the study is to estimate the influence of PEG placement on exponents of gastroesophageal reflux with the use of Multiple Intraluminal Impedance (MII/pH) in neurologically impaired children qualified for home enteral nutrition (HEN). Material and methods: The study comprised 14 children aged 4-16.7 years with chronic diseases of the central nervous system. All children underwent 24-hour multiple intraluminal impedance (MII/pH; SLEUTH Sandhill Scientific) monitoring - basic one before PEG placement and second one between 6-8 months of HEN duration. Minimal MII/pH monitoring time was 22 hours. All impedance recordings were visually inspected for the typical MII pattern of gastroesophageal reflux (GER). Acid, weakly-acid and non-acid reflux episodes, number and median duration of refluxes and symptom index (SI) comprising choking, coughing, emesis and regurgitation were calculated. Results: Based on MII-pH results pathological GER was detected at pre-PEG monitoring in 6/15 subjects (40.0%). The median number of refluxes was 26.93. The positive SI was observed in I child presenting with non-acid reflux. The second MII/pH revealed positive results in 2/14 children (13.3%): in 2 weakly-acid reflux were detected. Positive SI was reported in one subject (the same as in pre-PEG monitoring). The median number of reflux events was 24.73. Differences between indices of GER obtained by MII/pH before gastrostomy placement and on PEG feeding were not statistically significant. Enteral feeding improved clinical status (weight gain, frequency of regurgitation) of all patients with PEG regardless of MII-pH results. However, one subject demonstrated severe esophagitis and was placed on PEG/PEJ. Conclusions: The primary results of our MII/pH - PEG study suggest that the presence of GER does not exclude good clinical response to enteral feeding via gastrostomy in neurologically impaired children. The choice of route of enteral feeding supply should rely on clinical tolerance and MII/pH results with symptom index. [ABSTRACT FROM AUTHOR]

In the paper the problem of hypertrophy of adenoids is presented. Indications and contraindications for surgical procedure are discussed, and compared with those described 100 years ago. The role of endoscopic procedure in the diagnostics and surgery is stressed. [ABSTRACT FROM AUTHOR]