Division of Pediatric Surgery, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):686-90. doi: 10.1097/MPG.0b013e318202a3e5.
Gastroesophageal reflux (GER) and dismotility occur frequently after repair of esophageal atresia (EA). GER-associated complications can manifest either early or later; then precocious diagnosis and treatment are essential. The aim of the study was to evaluate characteristics of GER and esophageal clearance in children treated for EA with distal tracheoesophageal fistula, using pH-multichannel intraluminal impedance (pH-MII).
Twenty-two children (ages 3-40 months) treated for EA at birth, and 20 normal children of similar age with suspected GER disease were included in the study. Impedance parameters were analyzed according to age and symptoms.
Reflux events were mainly nonacidic. About bolus exposure index, mean acid clearing time (MACT), and mean bolus clearing time (MBCT), a significant difference was found between 2 groups: the median MACT and MBCT were longer, with values of 281 and 39 seconds, respectively, in the EA group and 110 and 15 seconds in the control group (P < 0.0005).
Our data show that in young patients the majority of refluxes are not acid. This implies that the incidence of GER may be underestimated if pH-metry is used. The pH-MII is an ideal test in children because it studies both GER with its characteristics and motility pattern. The quality of reflux does not seem to influence the onset of symptoms that are related to an impaired esophageal clearance. Hence, this technique could be useful to study patients treated for EA, avoiding the onset of complications.
食管闭锁（EA）修复后常发生胃食管反流（GER）和动力障碍。GER 相关并发症可早期或晚期出现；因此，早期诊断和治疗至关重要。本研究旨在使用 pH 多通道腔内阻抗（pH-MII）评估伴有远端气管食管瘘的 EA 患儿 GER 及食管清除功能的特征。
本研究纳入了 22 名出生时接受 EA 治疗的儿童（年龄 3-40 个月）和 20 名年龄相似的疑似 GER 疾病的正常儿童。根据年龄和症状分析阻抗参数。
反流事件主要是非酸性的。关于食团暴露指数、平均酸清除时间（MACT）和平均食团清除时间（MBCT），两组间存在显著差异：EA 组的中位 MACT 和 MBCT 较长，分别为 281 秒和 39 秒，而对照组分别为 110 秒和 15 秒（P < 0.0005）。
我们的数据表明，在年轻患者中，大多数反流不是酸性的。如果使用 pH 监测法，GER 的发生率可能被低估。pH-MII 是一种理想的儿童测试方法，因为它同时研究 GER 及其特征和动力模式。反流质量似乎不会影响与食管清除功能受损相关的症状的发生。因此，该技术可用于研究接受 EA 治疗的患者，避免并发症的发生。
