Added Value of pH Multichannel Intraluminal Impedance in Adults Operated for Esophageal Atresia

Abstract

Background Gastroesophageal reflux (GER) and dysphagia are common following repaired esophageal atresia (EA). The risk of esophagitis and Barrett esophagus is increased compared with the general population. As yet, the causes are not fully explained.

Purpose The aim of this study was to investigate how GER, measured by pH multichannel intraluminal impedance (pH-MII), is correlated to the esophageal symptoms and histological findings.

Methods Twenty-nine adult subjects operated for EA in Gothenburg from 1968 to 1983 were evaluated with pH-MII, manometry, and gastroscopy.

Results pH-MII was performed in 15, manometry in 19, and gastroscopy in 24 subjects. Eleven subjects displayed pathological reflux parameters of any kind, mainly nonacid reflux (10/15). Dysphagia correlated to the number of weakly acidic reflux episodes. Lower esophageal sphincter (LES) incompetence, which correlated to a pathological number of acid reflux episodes (p = 0.012), was noted in 21/24 subjects, but the majority had a normal resting pressure. Esophagitis was present in 14/24, two of whom had Barrett esophagus. Histological changes correlated to the reflux index and the number of weakly acidic reflux episodes (p = 0.028 and 0.040) and tended to correlate to dysphagia (p = 0.052).

Conclusion pH-MII adds further information when it comes to explaining what causes symptoms and esophageal histological changes in adults operated for EA.

Keywords

esophageal atresia - pH multichannel intraluminal impedance - gastroesophageal reflux - dysphagia - esophagitis

• References

• 1 Sistonen SJ, Koivusalo A, Nieminen U , et al. Esophageal morbidity and function in adults with repaired esophageal atresia with tracheoesophageal fistula: a population-based long-term follow-up. Ann Surg 2010; 251 (6) 1167-1173
• 2 Deurloo JA, Ekkelkamp S, Bartelsman JF , et al. Gastroesophageal reflux: prevalence in adults older than 28 years after correction of esophageal atresia. Ann Surg 2003; 238 (5) 686-689
• 3 Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 2002; 17 (2) 139-146
• 4 Ronkainen J, Agréus L. Epidemiology of reflux symptoms and GORD. Best Pract Res Clin Gastroenterol 2013; 27 (3) 325-337
• 5 Deurloo JA, Klinkenberg EC, Ekkelkamp S, Heij HA, Aronson DC. Adults with corrected oesophageal atresia: is oesophageal function associated with complaints and/or quality of life?. Pediatr Surg Int 2008; 24 (5) 537-541
• 6 Gatzinsky V, Jönsson L, Johansson C, Göthberg G, Sillén U, Friberg LG. Dysphagia in adults operated on for esophageal atresia—use of a symptom score to evaluate correlated factors. Eur J Pediatr Surg 2011; 21 (2) 94-98
• 7 Sifrim D, Fornari F. Esophageal impedance-pH monitoring. Dig Liver Dis 2008; 40 (3) 161-166
• 8 Savarino E, Marabotto E, Zentilin P , et al. The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease. Dig Liver Dis 2011; 43 (7) 542-547
• 9 Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut 2012; 61 (9) 1340-1354
• 10 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
• 11 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
• 12 Vela MF. Non-acid reflux: detection by multichannel intraluminal impedance and pH, clinical significance and management. Am J Gastroenterol 2009; 104 (2) 277-280
• 13 Gutschow CA, Bludau M, Vallböhmer D, Schröder W, Bollschweiler E, Hölscher AH. NERD, GERD, and Barrett's esophagus: role of acid and non-acid reflux revisited with combined pH-impedance monitoring. Dig Dis Sci 2008; 53 (12) 3076-3081
• 14 Schneider A, Michaud L, Gottrand F. Esophageal atresia: metaplasia, Barrett. Dis Esophagus 2013; 26 (4) 425-427
• 15 Shay S, Tutuian R, Sifrim D , et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol 2004; 99 (6) 1037-1043
• 16 Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 1974; 62 (4) 325-332
• 17 Lundell L, Abrahamsson H, Ruth M, Sandberg N, Olbe LC. Lower esophageal sphincter characteristics and esophageal acid exposure following partial or 360 degrees fundoplication: results of a prospective, randomized, clinical study. World J Surg 1991; 15 (1) 115-120 , discussion 121
• 18 Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001; 49 (1) 145-151
• 19 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
• 20 Ismail-Beigi F, Horton PF, Pope II CE. Histological consequences of gastroesophageal reflux in man. Gastroenterology 1970; 58 (2) 163-174
• 21 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
• 22 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
• 23 Tovar JA, Fragoso AC. Anti-reflux surgery for patients with esophageal atresia. Dis Esophagus 2013; 26 (4) 401-404
• 24 Rintala RJ, Sistonen S, Pakarinen MP. Outcome of esophageal atresia beyond childhood. Semin Pediatr Surg 2009; 18 (1) 50-56
• 25 Castilloux J, Bouron-Dal Soglio D, Faure C. Endoscopic assessment of children with esophageal atresia: Lack of relationship of esophagitis and esophageal metaplasia to symptomatology. Can J Gastroenterol 2010; 24 (5) 312-316
• 26 Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 2001; 120 (7) 1599-1606
• 27 Zerbib F, Roman S, Ropert A , et al. Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 2006; 101 (9) 1956-1963
• 28 Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996; 110 (6) 1982-1996
• 29 Tovar JA, Diez Pardo JA, Murcia J, Prieto G, Molina M, Polanco I. Ambulatory 24-hour manometric and pH metric evidence of permanent impairment of clearance capacity in patients with esophageal atresia. J Pediatr Surg 1995; 30 (8) 1224-1231
• 30 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
• 31 Tomaselli V, Volpi ML, Dell'Agnola CA, Bini M, Rossi A, Indriolo A. Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia. Pediatr Surg Int 2003; 19 (1-2) 40-43
• 32 Deurloo JA, Ekkelkamp S, Taminiau JA , et al. Esophagitis and Barrett esophagus after correction of esophageal atresia. J Pediatr Surg 2005; 40 (8) 1227-1231
• 33 Taylor AC, Breen KJ, Auldist A , et al. Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: a long-term follow-up study. Clin Gastroenterol Hepatol 2007; 5 (6) 702-706
• 34 Maynard S, Bouin M. Follow-up of adult patients with repaired esophageal atresia: how, when, and for how long?. Dis Esophagus 2013; 26 (4) 422-424
• 35 Voltaggio L, Montgomery EA, Lam-Himlin D. A clinical and histopathologic focus on Barrett esophagus and Barrett-related dysplasia. Arch Pathol Lab Med 2011; 135 (10) 1249-1260
• 36 Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ ; American Gastroenterological Association. American Gastroenterological Association technical review on the management of Barrett's esophagus. Gastroenterology 2011; 140 (3) e18-e52 , quiz e13
• 37 Fitzgerald RC, di Pietro M, Ragunath K , et al; British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014; 63 (1) 7-42
• 38 Richter JE, Wu WC, Johns DN , et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 1987; 32 (6) 583-592
• 39 Ayazi S, DeMeester SR, Hsieh CC , et al. Thoraco-abdominal pressure gradients during the phases of respiration contribute to gastroesophageal reflux disease. Dig Dis Sci 2011; 56 (6) 1718-1722