Download PDF
Eur J Pediatr Surg 2016; 26(04): 322-331
DOI: 10.1055/s-0035-1564715
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Gastroesophageal Reflux by Combined Multichannel Intraluminal Impedance and pH Monitoring and Esophageal Motility Patterns in Children with Esophageal Atresia

Stanley Tong
1   School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
,
Kylie-ann Mallitt
1   School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
,
Usha Krishnan
1   School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
2   Department of Pediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

22 June 2015

18 August 2015

Publication Date:
07 October 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Background Gastroesophageal reflux disease (GERD) and esophageal dysmotility are common in patients with esophageal atresia (EA). The aim of this study was to evaluate GERD and esophageal motility patterns in children with EA using combined multichannel intraluminal impedance and pH (MII-pH) monitoring and high-resolution esophageal manometry (HREM), respectively. The reflux patterns seen in EA patients were also compared with a control group of normal children with suspected GERD.

Methods A retrospective chart review was done on 35 patients with EA and 35 age- and sex-matched normal controls with suspected GERD, who had undergone 24-hour MII-pH monitoring. Impedance data were compared between both cohorts. Eight of the EA patients also underwent HREM.

Results In the EA cohort, the median age was 53 months, with 21 males, and 71.4% had Type C EA. A total of 85.7% of the EA cohort and 40% of the control group were on proton-pump inhibitor (PPI) therapy during the MII-pH study. There was no significant difference in the total retrograde bolus movements (RBMs) between the EA cohort (1,457) and the control group (1,482). Acidic RBMs was significantly lower in the EA group (208) compared with the control group (689), p = 0.0008. Nonacid reflux index (NARI) was significantly higher in EA children (1.1; 0.0–7.8) compared with controls (0.6; 0.0–5.7), p = 0.0046. In EA patients, only 335/1,183 (28%) total symptom occurrences were associated with RBM. The mean distal baseline impedance (DBI) was significantly lower in EA (1,029.6 [410.9 SD] Ω) compared with controls (2,998.2 [1028.8 SD] Ω) with suspected GERD, p < 0.0001. By logistic regression, only PPI use had a significant effect on DBI, p < 0.0001. HREM was abnormal in all eight EA patients. Four out of eight EA patients had a different peristaltic pattern for their solid swallows compared with their liquid swallows in HREM.

Conclusions MII-pH testing allowed increased detection of nonacid reflux events in EA patients, which would have been missed with standard pH monitoring alone. NARI was the only reflux parameter which was significantly higher in the EA cohort compared with the control group with suspected GERD. Majority (72%) of symptoms in EA patients were not temporally related to RBM in MII-pH testing. DBI was significantly lower in EA patients compared with controls. Esophageal motility by HREM was abnormal in all EA patients.

Keywords

esophageal atresia - impedance - gastroesophageal reflux - children - manometry
 

  • References

  • 1 Pinheiro PF, Simões e Silva AC, Pereira RM. Current knowledge on esophageal atresia. World J Gastroenterol 2012; 18 (28) 3662-3672
    CrossrefPubMedGoogle Scholar
  • 2 Di Pace MR, Caruso AM, Catalano P, Casuccio A, Cimador M, De Grazia E. Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring. J Pediatr Surg 2011; 46 (3) 443-451
    CrossrefPubMedGoogle Scholar
  • 3 Koivusalo A, Pakarinen MP, Rintala RJ. The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula—a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg 2007; 42 (2) 370-374
    CrossrefPubMedGoogle Scholar
  • 4 Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol 2008; 42 (5) 627-635
    CrossrefPubMedGoogle Scholar
  • 5 Fröhlich T, Otto S, Weber P , et al. Combined esophageal multichannel intraluminal impedance and pH monitoring after repair of esophageal atresia. J Pediatr Gastroenterol Nutr 2008; 47 (4) 443-449
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Lundell LR, Dent J, Bennett JR , et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45 (2) 172-180
    CrossrefPubMedGoogle Scholar
  • 8 Roman S, Savarino E, Savarino V, Mion F. Eosinophilic oesophagitis: from physiopathology to treatment. Dig Liver Dis 2013; 45 (11) 871-878
    CrossrefPubMedGoogle Scholar
  • 9 Liacouras CA, Ruchelli E. Eosinophilic esophagitis. Curr Opin Pediatr 2004; 16 (5) 560-566
    CrossrefPubMedGoogle Scholar
  • 10 Goldani HA, Staiano A, Borrelli O, Thapar N, Lindley KJ. Pediatric esophageal high-resolution manometry: utility of a standardized protocol and size-adjusted pressure topography parameters. Am J Gastroenterol 2010; 105 (2) 460-467
    CrossrefPubMedGoogle Scholar
  • 11 Tovar JA, Fragoso AC. Anti-reflux surgery for patients with esophageal atresia. Dis Esophagus 2013; 26 (4) 401-404
    CrossrefPubMedGoogle Scholar
  • 12 Ijsselstijn H, van Beelen NW, Wijnen RM. Esophageal atresia: long-term morbidities in adolescence and adulthood. Dis Esophagus 2013; 26 (4) 417-421
    CrossrefPubMedGoogle Scholar
  • 13 Vela MF. Medical treatments of GERD: the old and new. Gastroenterol Clin North Am 2014; 43 (1) 121-133
    CrossrefPubMedGoogle Scholar
  • 14 van Wijk M, Knüppe F, Omari T, de Jong J, Benninga M. Evaluation of gastroesophageal function and mechanisms underlying gastroesophageal reflux in infants and adults born with esophageal atresia. J Pediatr Surg 2013; 48 (12) 2496-2505
    CrossrefPubMedGoogle Scholar
  • 15 Catalano P, Di Pace MR, Caruso AM, Casuccio A, De Grazia E. Gastroesophageal reflux in young children treated for esophageal atresia: evaluation with pH-multichannel intraluminal impedance. J Pediatr Gastroenterol Nutr 2011; 52 (6) 686-690
    CrossrefPubMedGoogle Scholar
  • 16 Rintala RJ, Sistonen S, Pakarinen MP. Outcome of esophageal atresia beyond childhood. Semin Pediatr Surg 2009; 18 (1) 50-56
    CrossrefPubMedGoogle Scholar
  • 17 Friedmacher F, Puri P. Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome. Pediatr Surg Int 2012; 28 (9) 899-906
    CrossrefPubMedGoogle Scholar
  • 18 Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer III LR, Engum SA. Reoperation after Nissen fundoplication in children with gastroesophageal reflux: experience with 130 patients. Ann Surg 1997; 226 (3) 315-321 , discussion 321–323
    CrossrefPubMedGoogle Scholar
  • 19 Salvatore S, Hauser B, Vandemaele K, Novario R, Vandenplas Y. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology?. J Pediatr Gastroenterol Nutr 2005; 40 (2) 210-215
    CrossrefPubMedGoogle Scholar
  • 20 Lombardi G, de' Angelis G, Rutigliano V , et al. Reflux oesophagitis in children; the role of endoscopy. A multicentric Italian survey. Dig Liver Dis 2007; 39 (9) 864-871
    CrossrefPubMedGoogle Scholar
  • 21 Dhaliwal J, Tobias V, Sugo E , et al. Eosinophilic esophagitis in children with esophageal atresia. Dis Esophagus 2014; 27 (4) 340-347
    CrossrefPubMedGoogle Scholar
  • 22 Liacouras CA, Furuta GT, Hirano I , et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128 (1) 3-20.e6 , quiz 21–22
    CrossrefPubMedGoogle Scholar
  • 23 Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, Durup J, Husby S. Gastroesophageal reflux disease and eosinophilic esophagitis in infants and children. A study of esophageal pH, multiple intraluminal impedance and endoscopic ultrasound. Scand J Gastroenterol 2010; 45 (9) 1029-1035
    CrossrefPubMedGoogle Scholar
  • 24 Pederiva F, Burgos E, Francica I, Zuccarello B, Martinez L, Tovar JA. Intrinsic esophageal innervation in esophageal atresia without fistula. Pediatr Surg Int 2008; 24 (1) 95-100
    CrossrefPubMedGoogle Scholar
  • 25 Romeo G, Zuccarello B, Proietto F, Romeo C. Disorders of the esophageal motor activity in atresia of the esophagus. J Pediatr Surg 1987; 22 (2) 120-124
    CrossrefPubMedGoogle Scholar
  • 26 Tambucci R, Thapar N, Saliakellis E , et al. Clinical relevance of esophageal baseline impedance measurement: just an innocent bystander. J Pediatr Gastroenterol Nutr 2015; 60 (6) 776-782
    CrossrefPubMedGoogle Scholar
  • 27 Kessing BF, Bredenoord AJ, Weijenborg PW, Hemmink GJ, Loots CM, Smout AJ. Esophageal acid exposure decreases intraluminal baseline impedance levels. Am J Gastroenterol 2011; 106 (12) 2093-2097
    CrossrefPubMedGoogle Scholar
  • 28 Loots CM, Wijnakker R, van Wijk MP, Davidson G, Benninga MA, Omari TI. Esophageal impedance baselines in infants before and after placebo and proton pump inhibitor therapy. Neurogastroenterol Motil 2012; 24 (8) 758-762 , e351–e352
    CrossrefPubMedGoogle Scholar
  • 29 van der Pol RJ, Loots CM, Peeters L , et al. Outcomes of endoscopy and novel pH-impedance parameters in children: is there a correlation?. J Pediatr Gastroenterol Nutr 2013; 56 (2) 196-200
    CrossrefPubMedGoogle Scholar
  • 30 Salvatore S, Salvatoni A, Van Berkel M , et al. Esophageal impedance baseline is age dependent. J Pediatr Gastroenterol Nutr 2013; 57 (4) 506-513
    CrossrefPubMedGoogle Scholar
  • 31 Farré R, Blondeau K, Clement D , et al. Evaluation of oesophageal mucosa integrity by the intraluminal impedance technique. Gut 2011; 60 (7) 885-892
    CrossrefPubMedGoogle Scholar
  • 32 Blonski W, Hila A, Vela MF, Castell DO. An analysis of distal esophageal impedance in individuals with and without esophageal motility abnormalities. J Clin Gastroenterol 2008; 42 (7) 776-781
    CrossrefPubMedGoogle Scholar
  • 33 Agrawal A, Hila A, Tutuian R, Castell DO. Manometry and impedance characteristics of achalasia. Facts and myths. J Clin Gastroenterol 2008; 42 (3) 266-270
    PubMedGoogle Scholar
  • 34 Heard R, Castell J, Castell DO, Pohl D. Characterization of patients with low baseline impedance on multichannel intraluminal impedance-pH reflux testing. J Clin Gastroenterol 2012; 46 (7) e55-e57
    CrossrefPubMedGoogle Scholar
  • 35 Davies MR. Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula. Br J Surg 1996; 83 (9) 1268-1270
    CrossrefPubMedGoogle Scholar
  • 36 Aspirot A, Faure C. Esophageal dysmotility: characterization and pathophysiology. Dis Esophagus 2013; 26 (4) 405-409
    CrossrefPubMedGoogle Scholar
  • 37 Lemoine C, Aspirot A, Le Henaff G, Piloquet H, Lévesque D, Faure C. Characterization of esophageal motility following esophageal atresia repair using high-resolution esophageal manometry. J Pediatr Gastroenterol Nutr 2013; 56 (6) 609-614
    CrossrefPubMedGoogle Scholar