Retrospective Cohort Study
Copyright ©The Author(s) 2020 Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 19, 2020; 9(2): 29-43
Published online Sep 19, 2020. doi: 10.5409/wjcp.v9.i2.29
Gastroesophageal reflux disease in pediatric esophageal atresia: Assessment of clinical symptoms and pH-impedance data
Marina Aksionchyk, Kirill Marakhouski, Aliaksandr Svirsky
Marina Aksionchyk, Department of Pediatric Gastroenterology, Diagnostic Division, Republican Scientific and Practical Center for Pediatric Surgery, Minsk 220013, Belarus
Kirill Marakhouski, Department of Endoscopy, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
Aliaksandr Svirsky, Department of Pediatric surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
Author contributions: Aksionchyk M performed the pH-impedance testing and contributed to collection, analysis and interpretation of the patient’s clinical data, final diagnosis, and conception, drafting and revision of the manuscript for important intellectual content; Marakhouski K performed the upper gastrointestinal endoscopy, collection and analysis of the literature data, and statistical analyses, and contributed to conception, drafting and revision of the manuscript for important intellectual content; Svirsky A contributed to the acquisition and analysis of data, design of the work, and drafting and revision of the paper for important intellectual content; All authors gave final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by The National Centre of Pediatric Surgery at Minsk, Belarus, No. 24.08.2017.
Informed consent statement: All study participants and their legal guardian provided informed written consent prior to study participation, No. 37.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are 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: Marina Aksionchyk, MD, Doctor, Research Scientist, Department of Pediatric Gastroenterology, Diagnostic Division, Republican Scientific and Practical Center for Pediatric Surgery, Nezavisimosti Ave 64A, Minsk 220013, Belarus. marinaaksionchyk@dhc.by
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: June 15, 2020
Revised: June 28, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 19, 2020
Abstract
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.

Keywords: Esophageal atresia, Gastroesophageal reflux disease, pH-impedance testing, Mean nocturnal baseline impedance, Proximal reflux, Reflux esophagitis, Nonerosive reflux disease, Pediatric

Core Tip: Esophageal atresia (EA) is the most common congenital anomaly of the gastrointestinal tract. Gastroesophageal reflux disease (GERD) is a frequent and lifelong problem after EA repair. pH-impedance testing makes assessment of pH and other parameters of GERD possible, aiding disease diagnosis and management. Even asymptomatic patients should undergo monitoring of GERD to confirm the absence or the persistence of reflux, and the need to continue treatment. We analyzed data of children with EA open surgical repair to determine the features of GERD among them and propose some important issues for consideration in the follow-up program for these patients.