Koivusalo Antti, Pakarinen Mikko P, Rintala Risto J
Hospital for Children and Adolescents, University of Helsinki, PO BOX 281, 00029, Helsinki, Finland.
J Pediatr Surg. 2007 Feb;42(2):370-4. doi: 10.1016/j.jpedsurg.2006.10.010.
Gastrooesophageal reflux (GER) is common in patients with oesophageal atresia (OA). Complicated GER often manifests itself early after the primary repair (PR) and frequently requires antireflux surgery (ARS). How many patients will be later affected is unknown. We conducted an objective long-term follow-up for the cumulative incidence of OA-associated GER based on pH-metry and histology.
Sixty-one consecutive patients with their native oesophagus, who underwent PR for OA with a distal fistula from 1989 to 2004, were included. These children were grouped according to the Spitz classification with 77% as type I, 20% as type II, and 3% as type III. Significant heart disease, tracheomalacia, or gastric outlet obstruction occurred in 18.0 %, 9.8%, and 17.3% respectively, and a wide gap between esophageal segments occurred in 13.1%. Endoscopy and pH-metry at 1 year were followed up by endoscopy and selective pH-metry at 3, 5, and 10 years. Gastrooesophageal reflux was considered significant (sGER) when a patient underwent ARS, endoscopic biopsies disclosed at least moderate oesophagitis, or when total or preprandial reflux index were greater than 10% or 5%, respectively, with or without long (>5 minutes) reflux periods). Significant GER was considered resolved if, without need for ARS or medication, pH-metry or biopsies returned to normal and the patient was symptomless for at least 3 years.
The incidence of sGER/(number of assessed patients) at 6 months, 1 year, 3 years, 5 years, and 10 years was 16.3% (61), 39.3% (61), 44.2% (52), 51.2 % (43), and 44.4% (27). Overall, 28/61 (45.9%) of patients had sGER, and 18/28 (64.3%) patients underwent ARS. In one patient, sGER resolved during the follow-up.
The number of children with sGER associated with OA more than doubled from 6 months to 1 year after PR. Thereafter, there is a progressive increase in the incidence of sGER with age up to 5 years. Spontaneous resolution of sGER is rare.
胃食管反流（GER）在食管闭锁（OA）患者中很常见。复杂的GER常在初次修复（PR）后早期出现，且常需抗反流手术（ARS）。有多少患者随后会受到影响尚不清楚。我们基于pH监测和组织学对OA相关GER的累积发病率进行了客观的长期随访。
纳入1989年至2004年期间连续61例接受PR治疗远端瘘管型OA且保留自身食管的患者。这些儿童根据斯皮茨分类法分组，其中I型占77%，II型占20%，III型占3%。分别有18.0%、9.8%和17.3%的患者患有严重心脏病、气管软化或胃出口梗阻，13.1%的患者食管段之间存在较大间隙。在1年时进行内镜检查和pH监测，之后在3年、5年和10年进行内镜检查和选择性pH监测。当患者接受ARS、内镜活检显示至少为中度食管炎，或总反流指数或餐前反流指数分别大于10%或5%（无论是否有长于5分钟的反流期）时，胃食管反流被认为是显著的（sGER）。如果在无需ARS或药物治疗的情况下，pH监测或活检恢复正常且患者至少3年无症状，则认为显著GER已缓解。
6个月、1年、3年、5年和10年时sGER的发病率/（评估患者数）分别为16.3%（61例）、39.3%（61例）、44.2%（52例）、51.2%（43例）和44.4%（27例）。总体而言，28/61（45.9%）例患者有sGER，18/28（64.3%）例患者接受了ARS。1例患者在随访期间sGER缓解。
PR后6个月至1年，与OA相关的sGER患儿数量增加了一倍多。此后，sGER的发病率随年龄增长至5岁呈逐渐上升趋势。sGER自发缓解的情况很少见。
