OP‐13 REFLUX AND ESOPHAGEAL MOTILITY PATTERNS IN CHILDREN WITH ESOPHAGEAL ATRESIA
Authors: Krishnan U. , Tong S. 
Published: September 2015

Background:

gastresophageal reflux disease (GERD) and esophageal dysmotility are common in patients with esophageal atresia. The aim of this study was to evaluate GERD and esophageal motility patterns in children with EA using combined pH‐impedance (pH‐MII) monitoring and high resolution esophageal manometry (HREM) respectively. As a secondary aim the reflux patterns and distal baseline impedance (DBI) demonstrated in MII‐pH in EA patients were compared with those of normal children with suspected GERD

Methods:

A retrospective chart review was done on 35 patients with EA and 35 age and sex matched normal controls with suspected GERD. All patients underwent a 24 hour pH‐MII monitoring. If patients were on proton pump inhibitor (PPI) therapy, it was continued during the study. 8 of the EA patients also underwent HREM. Impedance data were compared between both cohorts. Endoscopy, clinical symptoms and patient demographics data was also collected.

Results:

In the EA cohort, the median age was 53 months, with 21 males and the majority (71.4%) had Type C EA. 85.7% of the EA cohort and 40% of the control group were on PPI therapy during the pH‐MII study. pH‐MII testing showed a total of 1457 retrograde bolus movement (RBM), of which only 14.3% was acidic in the EA cohort. In the control group there were 1482 RBMs of which 46.3% was acidic. There was no significant difference in the total RBMs between the two groups. Acidic RBMs was significantly lower in the EA group (208) compared to the control group (689), p = 0.0008, and non‐acid reflux index (NA RI) was significantly higher inEA children 1.1(0.0–7.8) compared to controls 0.6(0.0–5.7),p = 0.0046. There was no significant difference in total RBM, acid reflux index (ARI), and number of proximal reflux episodes between EA patients with and without fundoplication, long gap, esophagitis on biopsy and those on or off PPI. In EA patients out of total 1183 total symptom occurrences only 335 (28%) were associated with RBM. The mean DBI was significantly lower in EA 1029.6 (410.9SD) Ω compared to controls 2998.2 (1028.8SD) Ω with suspected GERD, p < 0.0001. By logistic regression only PPI use had a significant effect on DBI, p < 0.0001. None of the GER (ARI, NARI, or RBM) or bolus transit (mean acid clearance time (MACT), and bolus clearance time (BCT)) parameters or age had a significant effect on DBI. HREM was abnormal in all EA patients and demonstrated either aperistalsis, pressurization, weak peristalsis with small or large breaks or only distal peristalsis in those studied. 4 out of 8 EA patients had different peristaltic patterns for their solid swallows compared to their liquid swallows in HREM.

Conclusions:

pH‐MII testing allowed increased detection of non‐acid reflux events in EA patients which would have been missed with standard pH monitoring alone. NARI was the only reflux parameter which was significantly higher in the EA cohort compared to the control group with suspected GERD, but the clinical significance of NAR in EA patients remains to be determined. Majority (72%) of gastrointestinal symptoms in EA patients were not temporally related to RBM in pH‐MII testing. DBI was significantly lower in EA patients compared to controls, however its clinical relevance remains to be determined. Esophageal motility as determined by HREM was abnormal in all EA patients.