Evaluation of Gastroesophageal Reflux Disease One Year after Esophageal Atresia Repair: Paradigms Lost from a Single Snapshot?
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Nov 2020 · 1 min read
In brief
In brief
Study of 48 one-year-old children post-esophageal atresia repair found 69% had microscopic esophagitis but only 25% had pathological acid exposure, challenging the assumption that acid reflux causes esophagitis in this population. Results suggest chronic esophageal stasis from dysmotility may drive histological changes more than acid-induced GERD.
Written by the GCMD Library team from the article.
Objectives: to analyze the findings of both pH impedance (MII-pH) and endoscopy/histopathology in children with esophageal atresia at the age of one year, according to current recommendations for the diagnosis of gastroesophageal reflux disease (GERD) in EA.
Study design: We retrospectively reviewed both MII-pH and endoscopy/histopathology performed in one-year-old EA children, followed-up according to international recommendation. Demographics and clinical characteristics were also reviewed to investigate factors associated with abnormal GERD investigations.
Results: We included 48 children with esophageal atresia. Microscopic esophagitis was found in 33/48 patients (69%), and pathological esophageal acid exposure on MII-pH was detected in 12/48 (25%). Among baseline variables, only the presence of long-gap EA was associated with abnormal MII-pH. Distal baseline impedance was significantly lower in patients with microscopic esophagitis, and it showed a very good diagnostic performance in predicting histological changes.
Conclusions: histologic esophagitis is highly prevalent one year after EA repair, but our results do not support a definitive causative role of acid-induced GERD. Instead, they support the hypothesis that chronic stasis in the dysmotile esophagus might lead to histological changes. MII-pH may be a helpful tool in selecting patients who need closer endoscopic surveillance and/or benefit from acid suppression.
Keywords: baseline impedance; endoscopy; esophagitis; multichannel intraluminal impedance and pH; proton pump inhibitors.
DOI: 10.1016/j.jpeds.2020.09.015