Subscribe to RSS
DOI: 10.1055/s-0035-1564715
Evaluation of Gastroesophageal Reflux by Combined Multichannel Intraluminal Impedance and pH Monitoring and Esophageal Motility Patterns in Children with Esophageal Atresia
Publication History
22 June 2015
18 August 2015
Publication Date:
07 October 2015 (online)
![](https://www.thieme-connect.de/media/ejps/201604/lookinside/thumbnails/10-1055-s-0035-1564715_153528oa-1.jpg)
Abstract
Background Gastroesophageal reflux disease (GERD) and esophageal dysmotility are common in patients with esophageal atresia (EA). The aim of this study was to evaluate GERD and esophageal motility patterns in children with EA using combined multichannel intraluminal impedance and pH (MII-pH) monitoring and high-resolution esophageal manometry (HREM), respectively. The reflux patterns seen in EA patients were also compared with a control group of normal children with suspected GERD.
Methods A retrospective chart review was done on 35 patients with EA and 35 age- and sex-matched normal controls with suspected GERD, who had undergone 24-hour MII-pH monitoring. Impedance data were compared between both cohorts. Eight of the EA patients also underwent HREM.
Results In the EA cohort, the median age was 53 months, with 21 males, and 71.4% had Type C EA. A total of 85.7% of the EA cohort and 40% of the control group were on proton-pump inhibitor (PPI) therapy during the MII-pH study. There was no significant difference in the total retrograde bolus movements (RBMs) between the EA cohort (1,457) and the control group (1,482). Acidic RBMs was significantly lower in the EA group (208) compared with the control group (689), p = 0.0008. Nonacid reflux index (NARI) was significantly higher in EA children (1.1; 0.0–7.8) compared with controls (0.6; 0.0–5.7), p = 0.0046. In EA patients, only 335/1,183 (28%) total symptom occurrences were associated with RBM. The mean distal baseline impedance (DBI) was significantly lower in EA (1,029.6 [410.9 SD] Ω) compared with controls (2,998.2 [1028.8 SD] Ω) with suspected GERD, p < 0.0001. By logistic regression, only PPI use had a significant effect on DBI, p < 0.0001. HREM was abnormal in all eight EA patients. Four out of eight EA patients had a different peristaltic pattern for their solid swallows compared with their liquid swallows in HREM.
Conclusions MII-pH testing allowed increased detection of nonacid reflux events in EA patients, which would have been missed with standard pH monitoring alone. NARI was the only reflux parameter which was significantly higher in the EA cohort compared with the control group with suspected GERD. Majority (72%) of symptoms in EA patients were not temporally related to RBM in MII-pH testing. DBI was significantly lower in EA patients compared with controls. Esophageal motility by HREM was abnormal in all EA patients.
-
References
- 1 Pinheiro PF, Simões e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol 2012; 18 (28) 3662-3672
- 2 Di Pace MR, Caruso AM, Catalano P, Casuccio A, Cimador M, De Grazia E. Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring. J Pediatr Surg 2011; 46 (3) 443-451
- 3 Koivusalo A, Pakarinen MP, Rintala RJ. The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula—a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg 2007; 42 (2) 370-374
- 4 Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol 2008; 42 (5) 627-635
- 5 Fröhlich T, Otto S, Weber P , et al. Combined esophageal multichannel intraluminal impedance and pH monitoring after repair of esophageal atresia. J Pediatr Gastroenterol Nutr 2008; 47 (4) 443-449
- 6 Vandenplas Y, Rudolph CD, Di Lorenzo C , et al; North American Society for Pediatric Gastroenterology Hepatology and Nutrition; European Society for Pediatric Gastroenterology Hepatology and Nutrition. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49 (4) 498-547
- 7 Lundell LR, Dent J, Bennett JR , et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45 (2) 172-180
- 8 Roman S, Savarino E, Savarino V, Mion F. Eosinophilic oesophagitis: from physiopathology to treatment. Dig Liver Dis 2013; 45 (11) 871-878
- 9 Liacouras CA, Ruchelli E. Eosinophilic esophagitis. Curr Opin Pediatr 2004; 16 (5) 560-566
- 10 Goldani HA, Staiano A, Borrelli O, Thapar N, Lindley KJ. Pediatric esophageal high-resolution manometry: utility of a standardized protocol and size-adjusted pressure topography parameters. Am J Gastroenterol 2010; 105 (2) 460-467
- 11 Tovar JA, Fragoso AC. Anti-reflux surgery for patients with esophageal atresia. Dis Esophagus 2013; 26 (4) 401-404
- 12 Ijsselstijn H, van Beelen NW, Wijnen RM. Esophageal atresia: long-term morbidities in adolescence and adulthood. Dis Esophagus 2013; 26 (4) 417-421
- 13 Vela MF. Medical treatments of GERD: the old and new. Gastroenterol Clin North Am 2014; 43 (1) 121-133
- 14 van Wijk M, Knüppe F, Omari T, de Jong J, Benninga M. Evaluation of gastroesophageal function and mechanisms underlying gastroesophageal reflux in infants and adults born with esophageal atresia. J Pediatr Surg 2013; 48 (12) 2496-2505
- 15 Catalano P, Di Pace MR, Caruso AM, Casuccio A, De Grazia E. Gastroesophageal reflux in young children treated for esophageal atresia: evaluation with pH-multichannel intraluminal impedance. J Pediatr Gastroenterol Nutr 2011; 52 (6) 686-690
- 16 Rintala RJ, Sistonen S, Pakarinen MP. Outcome of esophageal atresia beyond childhood. Semin Pediatr Surg 2009; 18 (1) 50-56
- 17 Friedmacher F, Puri P. Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome. Pediatr Surg Int 2012; 28 (9) 899-906
- 18 Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer III LR, Engum SA. Reoperation after Nissen fundoplication in children with gastroesophageal reflux: experience with 130 patients. Ann Surg 1997; 226 (3) 315-321 , discussion 321–323
- 19 Salvatore S, Hauser B, Vandemaele K, Novario R, Vandenplas Y. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology?. J Pediatr Gastroenterol Nutr 2005; 40 (2) 210-215
- 20 Lombardi G, de' Angelis G, Rutigliano V , et al. Reflux oesophagitis in children; the role of endoscopy. A multicentric Italian survey. Dig Liver Dis 2007; 39 (9) 864-871
- 21 Dhaliwal J, Tobias V, Sugo E , et al. Eosinophilic esophagitis in children with esophageal atresia. Dis Esophagus 2014; 27 (4) 340-347
- 22 Liacouras CA, Furuta GT, Hirano I , et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128 (1) 3-20.e6 , quiz 21–22
- 23 Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, Durup J, Husby S. Gastroesophageal reflux disease and eosinophilic esophagitis in infants and children. A study of esophageal pH, multiple intraluminal impedance and endoscopic ultrasound. Scand J Gastroenterol 2010; 45 (9) 1029-1035
- 24 Pederiva F, Burgos E, Francica I, Zuccarello B, Martinez L, Tovar JA. Intrinsic esophageal innervation in esophageal atresia without fistula. Pediatr Surg Int 2008; 24 (1) 95-100
- 25 Romeo G, Zuccarello B, Proietto F, Romeo C. Disorders of the esophageal motor activity in atresia of the esophagus. J Pediatr Surg 1987; 22 (2) 120-124
- 26 Tambucci R, Thapar N, Saliakellis E , et al. Clinical relevance of esophageal baseline impedance measurement: just an innocent bystander. J Pediatr Gastroenterol Nutr 2015; 60 (6) 776-782
- 27 Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJ, Loots CM, Smout AJ. Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 2011; 106 (12) 2093-2097
- 28 Loots CM, Wijnakker R, van Wijk MP, Davidson G, Benninga MA, Omari TI. Esophageal impedance baselines in infants before and after placebo and proton pump inhibitor therapy. Neurogastroenterol Motil 2012; 24 (8) 758-762 , e351–e352
- 29 van der Pol RJ, Loots CM, Peeters L , et al. Outcomes of endoscopy and novel pH-impedance parameters in children: is there a correlation?. J Pediatr Gastroenterol Nutr 2013; 56 (2) 196-200
- 30 Salvatore S, Salvatoni A, Van Berkel M , et al. Esophageal impedance baseline is age dependent. J Pediatr Gastroenterol Nutr 2013; 57 (4) 506-513
- 31 Farré R, Blondeau K, Clement D , et al. Evaluation of oesophageal mucosa integrity by the intraluminal impedance technique. Gut 2011; 60 (7) 885-892
- 32 Blonski W, Hila A, Vela MF, Castell DO. An analysis of distal esophageal impedance in individuals with and without esophageal motility abnormalities. J Clin Gastroenterol 2008; 42 (7) 776-781
- 33 Agrawal A, Hila A, Tutuian R, Castell DO. Manometry and impedance characteristics of achalasia. Facts and myths. J Clin Gastroenterol 2008; 42 (3) 266-270
- 34 Heard R, Castell J, Castell DO, Pohl D. Characterization of patients with low baseline impedance on multichannel intraluminal impedance-pH reflux testing. J Clin Gastroenterol 2012; 46 (7) e55-e57
- 35 Davies MR. Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula. Br J Surg 1996; 83 (9) 1268-1270
- 36 Aspirot A, Faure C. Esophageal dysmotility: characterization and pathophysiology. Dis Esophagus 2013; 26 (4) 405-409
- 37 Lemoine C, Aspirot A, Le Henaff G, Piloquet H, Lévesque D, Faure C. Characterization of esophageal motility following esophageal atresia repair using high-resolution esophageal manometry. J Pediatr Gastroenterol Nutr 2013; 56 (6) 609-614