Macharia-Coates, Eva W.;
(2019)
Surgical Management of Gastroesophageal Reflux in Children: Risk Stratification and Prediction of Outcomes.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Introduction: Since the 1980s fundoplication, an operation developed for adults with hiatus hernia and reflux symptoms, has been performed in children with gastroesophageal reflux disease (GORD). When compared to adult outcomes, paediatric fundoplication has resulted in higher failure and revision rates. In the first chapter we explore differences in paradigm, patient population and outcomes. Firstly, symptoms are poorly defined and are measured by instruments of varying quality. Secondly, neurological impairment (NI), prematurity and congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia) are prevalent in children. / Purpose: To develop methods for stratifying paediatric fundoplication risk and predicting outcomes based on symptom profile, demographic factors, congenital and medical history. / Methods: Study objectives are addressed in three opera: a symptom questionnaire development (TARDIS:REFLUX), a randomised controlled trial (RCT) and a retrospective database study (RDS). TARDIS: REFLUX: In the second chapter, digital research methods are used to design and validate a symptom questionnaire for paediatric GORD. The questionnaire is a market-viable smartphone app hosted on a commercial platform and trialed in a clinical pilot study. / RCT: In the third chapter, the REMOS trial is reported. The trial addresses the subset of children with NI and feeding difficulties. Participants are randomized to gastrostomy with or without fundoplication. Notably, pre- and post-operative reflux is quantified using pH-impedance. / RDS: In the fourth chapter, data mining and machine learning strategies are applied to a retrospective paediatric GORD database. Predictive modelling techniques applied include logistic regression, decision trees, random forests and market basket analysis. / Results and conclusion: This work makes two key contributions. Firstly, an effective methodology for development of digital research tools is presented here. Secondly, a synthesis is made of literature, the randomised controlled trial and retrospective database modelling. The resulting product is an evidence-based algorithm for the surgical management of children with GORD.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Surgical Management of Gastroesophageal Reflux in Children: Risk Stratification and Prediction of Outcomes |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. |
| UCL classification: | UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10091738 |
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