Nutritional support was optimized with the help of a percutaneous gastrostomy (PEG, Figure 2B ) placed at the age of 3 years, which was used regularly; the gastrostomy was changed to a jejunostoma at the age of 61/2 years, to completely exclude gastro-esophageal refluxes, although no such events had been demonstrated in pHor impedance studies ( Figure 2B ).