Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula

Iwańczak, Barbara; Kosmowska-Miśków, Agnieszka; Kofla-Dłubacz, Anna; Palczewski, Mateusz; Grabiński, M; Pawłowska, Katarzyna; Matusiewicz, Krzysztof; Patkowski, Dariusz

doi:10.17219/acem/61844

Cited by 16 publications

(10 citation statements)

References 13 publications

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“…The prevalence of GERD in EA patients in our study was high (> 50%). Our results were similar to those from other studies of EA patients with pH-impedance monitoring[ 7 , 22 - 24 ]. The patients in our study were off PPI therapy for several weeks before examination (minimum being 1 wk).…”

Section: Discussionsupporting

confidence: 92%

Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data

Aksionchyk¹,

Marakhouski²,

Svirsky³

2020

WJCP

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BACKGROUND Esophageal atresia (EA) is the most common congenital anomaly of the gastrointestinal tract. Gastroesophageal reflux disease (GERD) is a frequent and lifelong problem in these patients. GERD can be asymptomatic and the incidence of esophageal gastric and intestinal metaplasia (Barrett’s esophagus) is increased in adults with EA compared with the general population. Timely and accurate diagnosis of GERD is important to reduce long-term problems and this may be achieved by pH-impedance testing. AIM To assess symptoms and pH-impedance data in children after EA, in order to identify their specific features of GERD. METHODS This study was conducted from November 2017 to February 2020 and involved 37 children who had undergone EA via open surgical repair (51.35% boys, 48.65% girls; age range: 1-14 years, median: 4.99 years). GERD diagnosis was made based on multichannel intraluminal impedance/pH study and two groups were established: EA without GERD, n = 17; EA with GERD, n = 20. A control group was established with 66 children with proven GERD (68.18% boys, 31.82% girls; median age: 7.21 years), composed of a nonerosive reflux disease (referred to as NERD) group ( n = 41) and a reflux esophagitis group ( n = 25). Upper gastrointestinal endoscopy with a mucosal esophageal biopsy was performed on all patients. RESULTS The most frequently observed symptom in EA patients with GERD and without GERD was cough (70% and 76.5% respectively). The number of patients with positive symptom association probability in the EA groups was significantly larger in the EA without GERD group ( P = 0.03). In the control reflux esophagitis group, prevalence of gastrointestinal symptoms was significantly higher than in the NERD group ( P = 0.017). For both EA groups, there was strong correlation with index of proximal events (IPE) and total proximal events (EA with GERD: 0.96, P < 0.001; EA without GERD: 0.97, P < 0.001) but level of IPE was significantly lower than in GERD patients without any surgical treatment ( P < 0.001). Data on distal mean nocturnal baseline impedance were significantly different between the EA with GERD group ( P < 0.001) and the two control groups but not between EA without GERD and the two control groups. CONCLUSION Mean nocturnal baseline impedance may have diagnostic value for GERD in EA children after open surgical repair. IPE might be an additional parameter of pH-impedance monitoring.

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Section: Discussionsupporting

confidence: 92%

Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data

Aksionchyk¹,

Marakhouski²,

Svirsky³

2020

WJCP

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“…EA patients frequently experience respiratory complications relted to GER, such as recurrent bronchitis, cough, choking, heartburn, and cyanotic episodes. [65] These can be a result of tranchomalacia, swallow dysfunction, or GERD reaching the proximal esophagus. pH-MII has the ability to determine if these symptoms correlate with reflux, regardless of acidity.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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“…Twenty studies reported results of endoscopic screening; a single endoscopy to assess for BO, which was undertaken at mean age of 20 years (median 16 years (range 16 months to 57 years)) 7 , 8 , 10 , 12 – 15 , 20 , 49 , 51 , 56 – 60 , 68 , 74 – 77 . While many of these studies, reporting screening endoscopies, suggested a requirement for further surveillance when BO was identified, few subsequently outlined their proposed surveillance regimen 68 .…”

Section: Resultsmentioning

confidence: 99%

Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair: a systematic review

et al. 2021

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Background Concern exists that patients born with oesophageal atresia (OA) may be at high risk for Barrett’s oesophagus (BO), a known malignant precursor to the development of oesophageal adenocarcinoma. Screening endoscopy has a role in early BO identification but is not universal in this population. This study aimed to determine prevalence of BO after OA repair surgery, to quantify the magnitude of this association and inform the need for screening and surveillance. Methods A systematic review, undertaken according to PRISMA guidelines, was preregistered on PROSPERO (CRD42017081001). PubMed and EMBASE were interrogated using a standardized search strategy on 31 July 2020. Included papers, published in English, reported either: one or more patients with either BO (gastric/intestinal metaplasia) or oesophageal cancer in patients born with OA; or long-term (greater than 2 years) follow-up after OA surgery with or without endoscopic screening or surveillance. Results Some 134 studies were identified, including 19 case reports or series and 115 single- or multi-centre cohort studies. There were 13 cases of oesophageal cancer (9 squamous cell carcinoma, 4 adenocarcinoma) with a mean age at diagnosis of 40.5 (range 20–47) years. From 6282 patients under long-term follow-up, 317 patients with BO were reported. Overall prevalence of BO was 5.0 (95 per cent c.i. 4.5 to 5.6) per cent, with a mean age at detection of 13.8 years (range 8 months to 56 years). Prevalence of BO in series reporting endoscopic screening or surveillance was 12.8 (95 per cent c.i. 11.3 to 14.5) per cent. Conclusion Despite a limited number of cancers, the prevalence of BO in patients born with OA is relatively high. While limited by the quality of available evidence, this review suggests endoscopic screening and surveillance may be warranted, but uncertainties remain over the design and effectiveness of any putative programme.

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Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula

Cited by 16 publications

References 13 publications

Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data

Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data

How to Care for Patients with EA-TEF: The Known and the Unknown

Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair: a systematic review

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