Cohen Sabban Judith, Bertoldi Gabriela D, Ussher Federico, Christiansen Silvia, Lifschitz Carlos, Orsi Marina
*Pediatric Gastroenterology Unit †Pathology Unit, Hospital Italiano Buenos Aires, Buenos Aires. Argentina.
J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):278-280. doi: 10.1097/MPG.0000000000001496.
The aim of the study was to determine whether esophageal baseline impedance (BI) values in children could be predictive of esophagitis.
Multichannel intraluminal impedance (MII) tracings of children 3 to 17 years of age suspected of having gastroesophageal reflux and esophagitis, who had also undergone upper endoscopy with multiple esophageal biopsies, were reviewed. Patients with eosinophilic esophagitis were excluded. Esophagitis was assessed by macroscopic and microscopic parameters. Esophageal histology was reported by 2 blinded independent pathologists unaware of the MII results. Mean BI was automatically calculated in the different MII channels (ch) by the specific software without removing any episode of increased/decreased BI. BI results were plotted against macroscopic and histological scores for each channel.
Tracings of 87 children, 53 boys, were evaluated. Mean age was 7.4 years: 45 had histologic esophagitis, 8 macroscopic. Histologic mild esophagitis (grade 1) was observed in 30, and 15 had moderate to severe esophagitis (grade 2-3). Ten had grade 3 esophagitis. Eight had macroscopic esophagitis as well.
in channel 6 of the MII, all 10 patients with grade 3 esophagitis and the 8 with macroscopic esophagitis had a BI <900 Ω/s (positive predictive value 100% and negative predictive value 100%), whereas none of those having a biopsy score of 0 to 2 or no endoscopic evidence of esophagitis had a mean BI below 2000 Ω/s.
The evaluation of the BI measured in channel 6 gave us 100% prediction of grade 3 and macroscopic esophagitis. BI on channel 6 may be useful to predict severe esophageal mucosa inflammation and could potentially be used for follow-up evaluation, rather than repeating an upper endoscopy. In addition, it would seem that grade 3 esophagitis even in the absence of macroscopic esophagitis affects the integrity of the esophageal epithelium.
本研究旨在确定儿童食管基线阻抗（BI）值是否可预测食管炎。
回顾了3至17岁疑似患有胃食管反流和食管炎且已接受上消化道内镜检查及多次食管活检的儿童的多通道腔内阻抗（MII）记录。排除嗜酸性食管炎患者。通过宏观和微观参数评估食管炎。由2名对MII结果不知情的独立盲法病理学家报告食管组织学情况。特定软件自动计算不同MII通道（ch）的平均BI，不排除任何BI升高/降低的情况。将每个通道的BI结果与宏观和组织学评分进行对比。
评估了87名儿童（53名男孩）的记录。平均年龄为7.4岁：45名有组织学食管炎，8名有宏观食管炎。观察到30名有组织学轻度食管炎（1级），15名有中度至重度食管炎（2 - 3级）。10名有3级食管炎。8名也有宏观食管炎。
在MII的通道6中，所有10名3级食管炎患者和8名有宏观食管炎的患者的BI均<900Ω/s（阳性预测值100%，阴性预测值100%），而活检评分为0至2或无食管炎内镜证据的患者中，无一例平均BI低于2000Ω/s。
对通道6中测量的BI进行评估可对3级和宏观食管炎做出100%的预测。通道6的BI可能有助于预测严重的食管黏膜炎症，并且有可能用于随访评估，而无需重复进行上消化道内镜检查。此外，即使没有宏观食管炎，3级食管炎似乎也会影响食管上皮的完整性。
