Pediatric Surgery Department. Hospital Universitario y Politécnico La Fe. Valencia (Spain).
Cir Pediatr. 2023 Jan 1;36(1):5-11. doi: 10.54847/cp.2023.01.13.
Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three.
Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared.
Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1).
Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.
最近的指南对食管闭锁（EA）患者胃食管反流的管理提出了建议。然而，一些诊断测试的时间仍有些不清楚。本研究调查了一岁和两岁或三岁儿童的胃食管反流测试。
回顾性研究了接受多通道腔内阻抗-pH 监测（MII-pH）和内镜-组织学检查的 EA 患者。进行检查时年龄为一岁的患者为 YO 组，年龄为两岁或三岁的患者为 OL 组。MII-pH 显著受损定义为反流总次数>105 或>85（取决于年龄），或反流指数>10%。内镜显著受损定义为糜烂性食管炎或 Barrett 食管。组织学显著受损定义为中重度食管炎或 Barrett 食管。比较了测试的常规参数和显著受损值。
研究了 24 名患者。进行了 23 次 MII-pH（YO 组 12 次，OL 组 11 次）：两组 MII-pH 的常规参数异常百分比无显著差异。进行了 20 次内镜活检（YO 组 7 次，OL 组 13 次）：食管炎的百分比无显著差异。有趣的是，YO 组所有测试中 26.9%显著受损，而 OL 组所有测试中 10.8%显著受损（χ2=2.7；p=0.1）。
考虑到 YO 组诊断测试的警示结果百分比，建议 EA 患者在一岁时进行 MII-pH 和内镜-组织学检查。
