Baclofen, an agonist of the GABAB receptor, while effective, has similar issues of needing frequent dosing in addition to greater adverse effects compared to other medications. Surgery
The standard surgical treatment for severe GERD is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. It is recommended only for those who do not improve with PPIs. Quality of life is improved in the short term compared to medical therapy, but there is uncertainty in the benefits of surgery versus long-term medical management with proton pump inhibitors. When comparing different fundoplication techniques, partial posterior fundoplication surgery is more effective than partial anterior fundoplication surgery, and partial fundoplication has better outcomes than total fundoplication.Esophagogastric dissociation is an alternative procedure that is sometimes used to treat neurologically impaired children with GERD. Preliminary studies have shown it may have a lower failure rate and a lower incidence of recurrent reflux.In 2012 the U.S. Food and Drug Administration (FDA) approved a device called the LINX, which consists of a series of metal beads with magnetic cores that are placed surgically around the lower esophageal sphincter, for those with severe symptoms that do not respond to other treatments. Improvement of GERD symptoms is similar to those of the Nissen fundoplication, although there is no data regarding long-term effects. Compared to Nissen fundoplication procedures, the procedure has shown a reduction in complications such as gas bloat syndrome that commonly occur.
Diagnosis
The diagnosis for argininemia can usually be done using fetal blood sample. One can look for the following indicators as to the presence of the condition:
Plasma ammonia concentration. Urinary orotic acid concentration
Red blood cell arginase enzyme activity (measurement)

Treatment
The treatment for infants (individuals) with argininemia is the following, including medications:

References
Further reading
(editors), Jean-Marie Saudubray, Georges van den Berghe, John H. Walter; Berghe, Georges van den; Walter, John H. (2012). Inborn metabolic diseases diagnosis and treatment (5th ed.). Berlin: Springer. ISBN 9783642157202. Retrieved 28 November 2016. {{cite book}}: |last1= has generic name (help)
Piña-Garza, J. Eric (2013). Fenichels Clinical pediatric neurology a signs and symptoms approach (7th ed.). Oxford: Saunders. ISBN 978-1455748129. Retrieved 28 November 2016. == External links ==