Features of the course and comparative characteristics of gastroesophageal reflux disease in pediatric patients with esophageal atresia after primary repair

Authors

  • M.G. Aksionchyk SI «Republican Scientific and practical Center of Pediatric Surgery», Belarus
  • K.Y. Marakhouski SI «Republican Scientific and practical Center of Pediatric Surgery», Belarus
  • V.I. Averin EE «Belarusian State Medical University», Belarus

DOI:

https://doi.org/10.15574/PS.2020.69.24

Keywords:

corrected esophageal atresia, gastroesophageal reflux disease, esophagitis, children, esophageal 24-hour pH/impedance measurement

Abstract

The aim is to evaluate clinical data and data of intraesophageal 24-hour pH/impedance measurement in pediatric patients with corrected esophageal atresia.

Material and methods. A retrospective analysis was carried out on the basis of inpatient records of 43 pediatric patients with corrected esophageal atresia (CEA) aged from 1 to 14 years, who were examined at the State Institution «Republican Scientific and Practical Center of Pediatric Surgery» from November 2017 to March 2020. Average age of the group: 5.09±1.2 years, of which 23 boys (53.5%), 20 girls (46.5%). All patients with CEA underwent esophagogastroduodenoscopy (EGD) and intraesophageal 24-hour pH/impedance measurement while off acid-suppressive therapy.

Results. Depending on the results of pH/impedance measurement, the patients with CEA were divided into two groups: CEA with gastroesophageal reflux disease (GERD) – 20 (54.1%) and CEA without GERD – 17 (45.9%). The most common symptom in patients with CEA was cough in both groups, in 26 (70.27%) children. Only in 4 out of 37 patients with CEA no symptoms during the time of the study were registered. Upper gastrointestinal tract endoscopy showed that 16 (43.2%) children with CEA had grade A esophagitis (according to the Los Angeles classification), 1 (2.7%) had gastric metaplasia of the esophageal mucosa, and 6 (16.2%) had chronic gastritis. EGD data did not reveal any significant differences between CEA patients with GERD and CEA patients without GERD (P=0.819). When comparing pH/impedance parameters, a significant difference (P<0.005) was obtained for the following parameters: reflux index, number of reflux episodes, distal mean nocturnal baseline impedance (MNBI) and duration of the longest reflux episode. In addition, the positive association of symptoms with episodes of refluxes (>95%) in the group of CEA patients without GERD was significantly higher than in CEA patients with GERD: 3/20 (15%) versus 8/17 (47.06%).

Conclusions. The prevalence of GERD in patients with CEA in this study was 54.06%. Extraesophageal symptoms (in particular, cough) are prevalent in patients with CEA (70.3%). GERD can be asymptomatic in patients with CEA. In this study, 15% of CEA patients with confirmed GERD were asymptomatic. Patients with CEA in the study groups rarely had typical GERD symptoms (heartburn, regurgitation, chest pain and belching).

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institutions indicated in the article. Informed consent of parents and children was obtained for the research.

 

References

Aksionchyk M, Marakhouski K, Svirsky A. (2020, September). Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data. World Journal of Clinical Pediatrics. 9(2): 2020. https://doi.org/10.5409/wjcp.v9.i2.29; PMid:33014720 PMCid:PMC7515750

Frazzoni M, Savarino E, De Bortoli N et al. (2016). Analyses of the post-reflux swallow-induced peristaltic wave index and nocturnal baseline impedance parameters increase the diagnostic yield of impedance-pH monitoring of patients with reflux disease. Clin Gastroenterol Hepatol. 14: 40-46. https://doi.org/10.1016/j.cgh.2015.06.026; PMid:26122764

Hassall E. (2011). Esophagitis and Barrett esophagus: Unifying the definitions and diagnostic approaches, with special reference to esophageal atresia. J Pediatr Gastroenterol Nutr. 52(1): 23-26. https://doi.org/10.1097/MPG.0b013e3182133143; PMid:21499040

Iwańczak BM, Kosmowska-Miśkow A, Kofla-Dłubacz A, Palczewski M, Grabiński M, Pawłowska K, Matusiewicz K, Patkowski D. (2016). Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula. Adv Clin Exp Med. 25(5): 917-922. https://doi.org/10.17219/acem/61844; PMid:28028956

Krishnan U, Mousa H, Dall'Oglio L et al. (2016). ESPGHANNASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. J Pediatr Gastroenterol Nutr. 63: 550-570.

https://doi.org/10.1097/MPG.0000000000001401; PMid:27579697

Krug E, Bergmeijer JH, Dees J, De Krijger R, Mooi WJ, Hazebroek FW. (1999). Gastroesophageal reflux and Barrett's esophagus in adults born with esophageal atresia. Am J Gastroenterol. 94: 2825-2828. https://doi.org/10.1111/j.1572-0241.1999.1423_c.x; PMid:10520828

Pedersen RN, Markow S, Kruse-Andersen S et al. (2013). Esophageal atresia: gastroesophageal functional follow-up in 5-15 year old children. J Pediatr Surg. 48: 2487-2495. https://doi.org/10.1016/j.jpedsurg.2013.07.019; PMid:24314192

Pilic D, Frohlich T, Noh F, Pappas A, Schmidt-Choudhury A, Kohler H, Skopnik H, Wenzl TG. (2011). Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German Pediatric Impedance Group. J Pediatr. 158(4): 650-654. https://doi.org/10.1016/j.jpeds.2010.09.033; PMid:21035128

Rintala RJ, Pakarinen MP. (2013). Long-term outcome of esophageal anastomosis. Eur J Pediatr Surg. 23: 219-225. https://doi.org/10.1055/s-0033-1347912; PMid:23737132

Rosen R, Vandenplas Y, Singendonk M et al. (2018, March). 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. https://doi.org/10.1097/MPG.0000000000001889; PMid:29470322 PMCid:PMC5958910

Stanley Tong Kylie-ann Mallitt Usha Krishnan. (2015, August 18). Evaluation of gastroesophageal reflux by combined multichannel intraluminal impedance and pH monitoring and esophageal motility patterns in children with esophageal atresia. Eur J Pediatr Surg.

Tovar JA, Fragoso AC. (2013). Gastroesophageal reflux after repair of esophageal atresia. Eur J Pediatr Surg. 23: 175-181. https://doi.org/10.1055/s-0033-1347911; PMid:23720211

Wenzl TG, Benninga MA, Loots CM, Salvatore S, Vandenplas Y. (2012). ESPGHAN EURO-PIG Working Group. Indications, Methodology, and Interpretation of Combined Esophageal Impedance-pH Monitoring in Children: ESPGHAN EURO-PIG Standard Protocol. 55(2): 230-234. https://doi.org/10.1097/MPG.0b013e3182592b65; PMid:22711055

Published

2020-12-30

Issue

Section

Original articles. Thoracic surgery