Impedance Testing in Esophageal Atresia Patients

Hassan, Maheen; Mousa, Hayat

doi:10.3389/fped.2017.00085

Cited by 7 publications

(5 citation statements)

References 45 publications

(66 reference statements)

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“…It is also able to correlate extra-gastrointestinal symptoms to reflux, which may help guide treatment. pH-impedance is also useful in quantifying the proportion of reflux reaching up to the proximal esophagus, referred to as “high reflux.” EA patients frequently experience extraesophageal symptoms, and pH-MII has the unique ability to determine if these symptoms correlate with reflux episodes, regardless of whether they involve acid or non-acid[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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

Aksionchyk¹,

Marakhouski²,

Svirsky³

2020

WJCP

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“…This could partly explain the absence of symptomatology, since clearance has influence on it, as Maheen Hassan refers in her work [31].…”

Section: Discussionmentioning

confidence: 97%

High-Resolution Esophageal Manometry in Teenagers with Esophageal Atresia

Zubiri¹,

Ramos²,

Curvale³

et al. 2020

OJEpi

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Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, which allowed to know the segmental alterations. Objective: To describe the esophageal motility patterns found through HRM in teenagers with EA and to relate these with the associated esophageal pathology and its severity. Materials and Method: Ten teenagers were included with no history of esophageal blockage or dilations in the last six months, who were orally fed and asymptomatic. Through performance of HRM, we found surgical and endoscopic history, as well as of esophageal biopsies and pH monitoring. Results: We found the following patterns: aperistalsis, pressurization and distal contraction. 70% showed distal contraction, and 100% of esophageal endoscopies and biopsies were normal. 57% of the esophageal pH monitoring analyzed was pathologic. In the pressurization and aperistalsis groups, we observed severe esophagitis and requirement of Nissen antireflux procedure in 100% of the cases. Esophageal pH monitoring analyzed was 100% pathologic. Conclusion: We described the esophageal segmental alterations in teenagers with atresia by means of HRM. The distal contraction group showed better development, without severe esophagitis or requirement of antireflux procedure. Therefore,

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“…The following MII-pH parameters were registered: reflux index (percentage of time with pH < 4), acid clearance time, total reflux episodes, acid reflux episodes (with a nadir pH < 4), non-acid reflux episodes (with a nadir pH ≥ 4), bolus clearance time (in the most distal channel), percentage of proximal reflux episodes (which reached the two proximal impedance electrodes) and mean impedance baseline. The following values of MII-pH parameters were considered abnormal, taking previous works into account: reflux index >5%; acid clearance time >114.4; total reflux episodes >71; acid reflux episodes >55; non-acid reflux episodes >34; bolus clearance time >32 (17,18) . A MII-pH was considered substantially impaired (SI-MMI-pH) when a patient had a total number of reflux episodes >105 (for <2 years of age) or >85 (for >2 years of age); or a reflux index >10% (19,20) .…”

Section: Methodsmentioning

confidence: 99%

Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia

Couselo¹,

Ibáñez²,

Ortolá³

et al. 2023

Cir Pediatr

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Objective. Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three.Material and methods. Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared.Results. Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ 2 = 2.7; p = 0.1). Conclusion.Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

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Impedance Testing in Esophageal Atresia Patients

Cited by 7 publications

References 45 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

High-Resolution Esophageal Manometry in Teenagers with Esophageal Atresia

Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia

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