Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2020; 26(28): 4159-4169
Published online Jul 28, 2020. doi: 10.3748/wjg.v26.i28.4159
Detection of reflux-symptom association in children with esophageal atresia by video-pH-impedance study
Settachote Maholarnkij, Anapat Sanpavat, Katawaetee Decharun, Termpong Dumrisilp, Chomchanat Tubjareon, Benjawan Kanghom, Tanisa Patcharatrakul, Nataruks Chaijitraruch, Voranush Chongsrisawat, Palittiya Sintusek
Settachote Maholarnkij, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Anapat Sanpavat, Division of Pathology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Katawaetee Decharun, Division of Pediatric Surgery, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Katawaetee Decharun, Benjawan Kanghom, Nataruks Chaijitraruch, Palittiya Sintusek, Division of Gastroenterology, and Pediatric Gastroenterology and Hepatology STAR (Special Task Force for Activating Research), Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Termpong Dumrisilp, Chomchanat Tubjareon, Benjawan Kanghom, Nataruks Chaijitraruch, Voranush Chongsrisawat, Palittiya Sintusek, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Tanisa Patcharatrakul, Center of Excellence in Neurogastroenterology and Motility, Department of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Tanisa Patcharatrakul, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Author contributions: Maholarnkij S participated in design of the study, drafted the manuscript, collected the data, assisted with data analysis; Sunpavat A interpreted the histopathological data; Decharun K was involved with data collection and approved the final manuscript; Dumrisilp T, Tubjareon C and Kanghom B was involved with data collection; Chaijitraruch N, Patcharatrakul T and Chongsrisawat V approved the final manuscript; Sintusek P designed and oversight of the study, involved with data collection, interpretation and analysis, draft and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institional Review Board of Chulalongkorn University, Thailand (IRB number 243/61).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrolment.
Conflict-of-interest statement: The authors of this manuscript having no conflict of interest to disclose.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, Assistant Professor, Department of Gastroenterology and Pediatric Liver Diseases and Immunology STAR (Special Task Force for Activating Research), Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, No. 1873, Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: March 12, 2020
Peer-review started: March 12, 2020
First decision: April 25, 2020
Revised: April 30, 2020
Accepted: July 14, 2020
Article in press: July 14, 2020
Published online: July 28, 2020
Abstract
BACKGROUND

Children with esophageal atresia (EA) have risk of gastroesophageal reflux disease (GERD), suggesting reflux monitoring for prompt management.

AIM

To evaluate GERD in children with EA and specific symptom association from combined Video with Multichannel Intraluminal Impedance and pH (MII-pH) study.

METHODS

Children diagnosed with EA with suspected GERD and followed up at King Chulalongkorn Memorial Hospital between January 2000 and December 2018 were prospectively studied. All underwent esophagogastroduodenoscopy with esophageal biopsy and Video MII-pH study on the same day. Symptoms of GERD which included both esophageal and extra-esophageal symptom were recorded from video monitoring and abnormal reflux from MII-pH study based on the statement from the European Paediatric Impedance Group. Prevalence of GERD was also reported by using histopathology as a gold standard. Endoscopic appearance was recorded using Los Angeles Classification and esophagitis severity was graded using Esohisto criteria.

RESULTS

Fifteen children were recruited with age of 3.1 (2.2, 9.8) years (40%, male) and the common type was C (93.3%). The symptoms recorded were cough (75.2%), vomiting (15.2%), irritability or unexplained crying (7.6%) and dysphagia (1.9%) with the symptom-reflux association of 45.7%, 89%, 71% and 0%, respectively. There were abnormal endoscopic appearance in 52.9%, esophagitis in 64.7% and high reflux score in 47.1%. Video MII-pH study has high diagnostic value with the sensitivity, specificity and accuracy of 72.7%, 100% and 82.4%, respectively.

CONCLUSION

Prevalence of GERD in children with EA was high. Video MII-pH study to detect GERD in children with EA had high diagnostic value with the trend of specific symptom association.

Keywords: Gastroesophageal reflux disease, Esophageal atresia, Children, Impedance pH study, Video, Symptom association

Core tip: This was a cross sectional study with 15 patients diagnosed with esophageal atresia (EA) and suspected gastroesophageal reflux disease (GERD). Combined Video Multichannel Intraluminal Impedance and pH study has a good diagnostic accuracy to diagnose GERD in these children and there was a trend of specific symptom-reflux association in children diagnosed with EA.