Gastroesophageal Reflux in Young Children Treated for Esophageal Atresia: Evaluation With pH‐Multichannel Intraluminal Impedance

Abstract

Our data show that in young patients the majority of refluxes are not acid. This implies that the incidence of GER may be underestimated if pH-metry is used. The pH-MII is an ideal test in children because it studies both GER with its characteristics and motility pattern. The quality of reflux does not seem to influence the onset of symptoms that are related to an impaired esophageal clearance. Hence, this technique could be useful to study patients treated for EA, avoiding the onset of complications.

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

“…Di Pace et al [21], using MII/pH, demonstrated that in children who underwent a corrective operation for EA/TEF, gastroesophageal reflux disease was frequent and that the time of bolus clearance, acid clearance and time of bolus passage were pathological. Catalano et al [22] demonstrated a correlation of gastroesophageal reflux disease with non-acid reflux.…”

Impedance Testing in Esophageal Atresia Patients

“…Of these high refluxes, 47% were weakly acidic and 53% were acidic. In another study, 62% of coughs were associated with reflux in children ≤1 year old, and 58% of coughs were associated with reflux in children >1 year old (39). Cough episodes were more commonly seen with acid reflux, though compared to children >1 year old, younger children had more frequent cough episodes related to non-acid reflux.…”

“…Comparing infants with EA and controls with GER, the mean ACT and mean BCT are significantly longer in the EA group (39). Correlation between symptoms and clearance time in the EA group showed that the median ACT and BCT were significantly shorter in patients without symptoms than in those with symptoms.…”

“…Since many EA patients are already on anti-reflux therapy, may have a frequent feeding schedule, or may be on tube feeds, the majority of their refluxate is non-acidic and would otherwise be missed by conventional pH testing (28). In a study comparing infants with EA and controls with GER, reflux events in both groups were mainly non-acid (39). Weakly acid reflux has also been shown to be responsible for a significant percentage of symptoms in EA patients (29).…”

The Potential Benefits of Applying Recent Advances in Esophageal Motility Testing in Patients with Esophageal Atresia

“…A lack of sensitivity of the used technologies and/or the absence of an integrated analysis method of manometry and impedance recordings or the fact that normal clearance can also be achieved with abnormal motility patterns may be potential reasons (8). Given children with EA may undergo many radiological investigations over their lifetime, a non-radiological alternative for radiology requires investigation (9–11). …”