Published online Jul 28, 2020. doi: 10.3748/wjg.v26.i28.4159
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
Esophageal atresia (EA) is a common digestive malformation with increasing risk of esophageal complications even after successful surgical correction. Gastroesophageal reflux disease (GERD) is the frequent gastrointestinal co-morbidity causing serious long-term consequences namely esophageal stricture and esophageal carcinoma. Hence, early detection and prompt treatment are crucial.
This research aimed to study the prevalence of GERD using esophageal histopathology and the novel tool, combined Video Multichannel Intraluminal Impedance and pH (MII-pH) study, in children diagnosed with EA. We believe that symptoms from video monitoring should be recorded more precisely with time reflux than by caregivers and make the interpretation of reflux-symptom association more meaningful.
To investigate the prevalence of GERD and the symptom association in children diagnosed EA by combined Video MII-pH study.
Seventeen investigations that included esophagogastroduodenoscopy with biopsy and combined Video MII-pH study were performed in 15 children diagnosed EA. All signs and symptoms of GERD from video were recorded during MII-pH monitoring. MII-pH study was manually analysis including the symptom-reflux association using the symptoms from video record. Diagnostic value of combined Video MII-pH study was calculated using the result of esophageal histopathology as the gold standard to diagnose GERD.
The total symptoms recorded from video of all 17 combined Video MII-pH monitoring were cough (67.3%), vomiting (17.3%), irritability or unexplained crying (13.4%) and dysphagia (1.9%). In aspect of symptom association, vomiting was the symptom that mostly associated with reflux followed by irritability or unexplained crying and cough. Using esophageal histopathology as the gold standard for GERD, combined Video MII-pH has high diagnostic value with the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 72.7%, 100%, 100%, 67% and 82.4%, respectively.
Prevalence of GERD in children with EA was high. Combined Video MII-pH study to detect GERD in children with EA had high diagnostic value with the trend of specific symptom association.
MII-pH study has limitation to be the gold-standard test for GERD as the data of the reflux value in each age group are scarce. To improve the utility and diagnostic value of this machine, we synchronized the video recording during the study. The precise time of symptom recorded from video could increase symptom-reflux association albeit its time consuming. In the future, real-time Video MII-pH monitoring machine should be developed to improve the accuracy and clinical utility of MII-pH study.