Why this work is in the frame
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Bibliographic record
Abstract
Children with gastroesophageal reflux disease (GERD) refractory to medical treatment may benefit from a fundoplication. Unfortunately, postoperative complications are not uncommon and may result in failure of the fundoplication in up to 25% to 40% of all cases. Many children respond positively to proton pump inhibitors, and surgery may be associated with a failure rate and complications. On closer inspection, the benefit of surgery for GERD, in children, is debated. For pediatric patients, there have been no prospective randomized trials comparing fundoplication with proton pump inhibitors. In addition, there have been no prospective randomized control trials evaluating open versus laparoscopic fundoplications in children. However, in the adult population, there have been several prospective trials including the Nordic Gord study group, a randomized clinical trial comparing proton pump inhibitors with surgical therapy for reflux esophagitis, showing that both treatment arms after 7 years (antireflux surgery or omeprazole groups) were equivalent for treating GERD. Despite surgery being more effective in controlling overall disease symptoms, surgery did have specific postfundoplication complaints that remained a problem. Similarly, another prospective trial of laparoscopic Nissen fundoplication versus proton pump inhibitor therapy for GERD at 7-year follow-up found that both optimal proton pump inhibitor therapy and laparoscopic Nissen fundoplication were effective treatment for GERD. The difference was that surgery did add additional benefit for those who had only partial symptom relief while on proton pump inhibitors. The Lotus trial from Europe, comparing the laparoscopic antireflux surgery with esomeprazole in the management of patients with GERD, shows, at the 3-year interim analysis, that both laparoscopic fundoplication and continuous esomeprazole therapy are similarly effective and well-tolerated therapeutic strategies, providing effective control of GERD. Thus, it appears, in adult literature, that proton pump inhibitors are equivalent to fundoplication in the randomized control trials in a prospective fashion. Unfortunately, for children we have no such trials. Perhaps we can rely on the adult literature and look back at our own children’s hospital series to evaluate truly the effectiveness of fundoplication over the years and see if we need to have a paradigm shift in our way of evaluating for GERD as well as offering possible management therapies that provide the most effective solution for some of these complex children with GERD. We wanted to review at our institution the evolution of evaluating children with GERD, their treatment, and their outcomes with an emphasis on the changing views as new evidence builds throughout the years for GERD outcomes. The purpose of this study is thus to elucidate the outcomes of fundoplication including identification of risk factors for abdominal reoperations at our institution. Other articles have looked at the outcomes of fundoplications as a need for reoperation with a redo fundoplication. However, we feel that the redo fundoplication only tells a portion of the entire story, and thus, we wanted to look at all surgical readmissions requiring abdominal surgery for children having had a fundoplication.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it