Why to Use Intraluminal Impedance in the Evaluation of Children with Repaired Esophageal Atresia

Introduction: Gastroesophageal reflux disease (GERD) and esophageal dysmotility are frequent in esophageal atresia (EA) patients. The aim of this study was to assess the role of intraluminal impedance (MII-pH) in the evaluation of GERD in children with repaired EA. Materials and Methods: The medical records of 13 pediatric patients with repaired Gross type C EA were reviewed retrospectively. The MII-pH recordings were analyzed by software automatically and the results were then reviewed manually. The results of barium studies including upper gastrointestinal tract series and videofluoroscopic swallowing studies were also reviewed to evaluate dysmotility. Results: The most common extra-esophageal and esophageal complaints were recurrent pulmonary infections (92%) and dysphagia (77%). pH measurements showed a median reflux index (RI) of 3.8% (0.1-35.4) with 38% (n=5) of patients having pathologic RI (RI >5%). In impedance analyses, 70% of the reflux episodes were non-acidic (4 <= pH). Percent of patients having non-acidic retrograde bolus movements (RBM) above 95(th) percentile of normal values was 38% (n=5). Five of the 8 patients with normal pH monitoring results had pathological non-acid RBM in impedance analyses. Esophageal motility problem was a common finding (n=10, 77%) followed by pharyngeal phase problems (n=5, 38.5%) in contrast studies. Conclusion: Majority of the RBM in repaired EA patients were non-acidic which would have gone undetected with standard pH monitoring. Half of the patients with pathologic reflux indices could only be detected by impedance monitoring. MII-pH monitoring should be preferred over conventional pH monitoring in the surveillance of EA patients.

Automated summary

This study assessed the role of intraluminal impedance (MII-pH) in evaluating GERD in children with repaired esophageal atresia (EA). The results showed that the majority of reflux episodes in these patients were non-acidic and could not be detected with standard pH monitoring. Therefore, MII-pH monitoring should be preferred over conventional pH monitoring in the surveillance of EA patients.