Endoscopic Surveillance for Congenital Diaphragmatic Hernia: Unexpected Prevalence of Silent Esophagitis

Abstract

Introduction Gastroesophageal reflux disease (GERD) is a frequent comorbidity after congenital diaphragmatic hernia (CDH) repair. Our aim was to evaluate the clinical and endoscopic prevalence of esophagitis in a long-term follow-up of CDH patients.

Materials and Methods Patients operated on for posterolateral CDH and undergoing general anesthesia for concomitant pathologies between January and October 2013 were included in the study. GERD was investigated both clinically (Manterola questionnaire) and endoscopically. The severity of esophagitis was evaluated according to the Hetzel–Dent classification and multiple biopsies were performed. The correlation between clinical score and severity of esophagitis was evaluated.

Results Twelve patients were included in the study (mean age: 14.5 years; range, 9–18 years). Only three children (25%) had a pathological questionnaire. At endoscopy, three children (25%) were affected by grade 1 esophagitis, six (50%) by grade 2, two (17%) by grade 3, and one (8%) by grade 4. One of the children presented Barrett esophagus. A moderate negative correlation was found between clinical data and endoscopic findings (r: −0.54 and p: 0.067).

Conclusion Even in the absence of symptoms, esophagitis revealed to have a high prevalence in CDH patients. A long-term clinical and instrumental follow-up is mandatory to early diagnose and treat GERD.

Keywords

esophagitis - congenital diaphragmatic hernia - GERD

• References

• 1 Mielniczuk M, Kusza K, Brzeziński P, Jakubczyk M, Mielniczuk K, Czerwionka-Szaflarska M. Current management of congenital diaphragmatic hernia. Anaesthesiol Intensive Ther 2012; 44 (4) 232-237
• 2 Tovar JA. Congenital diaphragmatic hernia. Orphanet J Rare Dis 2012; 7 (3) 1
• 3 Lally KP, Engle W ; American Academy of Pediatrics Section on Surgery; American Academy of Pediatrics Committee on Fetus and Newborn. Postdischarge follow-up of infants with congenital diaphragmatic hernia. Pediatrics 2008; 121 (3) 627-632
• 4 Vanamo K, Rintala RJ, Lindahl H, Louhimo I. Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects. J Pediatr Surg 1996; 31 (4) 551-554
• 5 Steven MJ, Fyfe AH, Raine PA, Watt I. Esophageal adenocarcinoma: a long-term complication of congenital diaphragmatic hernia?. J Pediatr Surg 2007; 42 (7) E1-E3
• 6 Koivusalo AI, Pakarinen MP, Lindahl HG, Rintala RJ. The cumulative incidence of significant gastroesophageal reflux in patients with congenital diaphragmatic hernia-a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg 2008; 43 (2) 279-282
• 7 Manterola C, Muñoz S, Grande L, Bustos L. Initial validation of a questionnaire for detecting gastroesophageal reflux disease in epidemiological settings. J Clin Epidemiol 2002; 55 (10) 1041-1045
• 8 Hetzel DJ, Dent J, Reed WD , et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 1988; 95 (4) 903-912
• 9 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
• 10 Lassen A, Hallas J, de Muckadell OB. Esophagitis: incidence and risk of esophageal adenocarcinoma—a population-based cohort study. Am J Gastroenterol 2006; 101 (6) 1193-1199
• 11 D'Agostino JA, Bernbaum JC, Gerdes M , et al. Outcome for infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: the first year. J Pediatr Surg 1995; 30 (1) 10-15
• 12 Fasching G, Huber A, Uray E, Sorantin E, Lindbichler F, Mayr J. Gastroesophageal reflux and diaphragmatic motility after repair of congenital diaphragmatic hernia. Eur J Pediatr Surg 2000; 10 (6) 360-364
• 13 Stolar CJ, Levy JP, Dillon PW, Reyes C, Belamarich P, Berdon WE. Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia. Am J Surg 1990; 159 (2) 204-207
• 14 Kieffer J, Sapin E, Berg A, Beaudoin S, Bargy F, Helardot PG. Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 1995; 30 (9) 1330-1333
• 15 Peetsold MG, Kneepkens CM, Heij HA, IJsselstijn H, Tibboel D, Gemke RJ. Congenital diaphragmatic hernia: long-term risk of gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2010; 51 (4) 448-453
• 16 Shawyer AC, D'Souza J, Pemberton J, Flageole H. The management of postoperative reflux in congenital esophageal atresia-tracheoesophageal fistula: a systematic review. Pediatr Surg Int 2014; 30 (10) 987-996
• 17 Pedersen RN, Markøw S, Kruse-Andersen S , et al. Esophageal atresia: gastroesophageal functional follow-up in 5-15 year old children. J Pediatr Surg 2013; 48 (12) 2487-2495