Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Detection of reflux-symptom association in children with esophageal atresia by video-pH-impedance study
Settachote Maholarnkij, Anapat Sanpavat, Katawaetee Decharun, Termpong Dumrisilp, Chomchanat Tubjareon, Benjawan Kanghom, Tanisa Patcharatrakul, Nataruks Chaijitraruch, Voranush Chongsrisawat, Palittiya Sintusek
Settachote Maholarnkij, Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Anapat Sanpavat, Division of Pathology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Katawaetee Decharun, Division of Pediatric Surgery, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Katawaetee Decharun, Benjawan Kanghom, Nataruks Chaijitraruch, Palittiya Sintusek, Division of Gastroenterology, and Pediatric Gastroenterology and Hepatology STAR (Special Task Force for Activating Research), Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Termpong Dumrisilp, Chomchanat Tubjareon, Benjawan Kanghom, Nataruks Chaijitraruch, Voranush Chongsrisawat, Palittiya Sintusek, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Tanisa Patcharatrakul, Center of Excellence in Neurogastroenterology and Motility, Department of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Tanisa Patcharatrakul, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Author contributions: Maholarnkij S participated in design of the study, drafted the manuscript, collected the data, assisted with data analysis; Sunpavat A interpreted the histopathological data; Decharun K was involved with data collection and approved the final manuscript; Dumrisilp T, Tubjareon C and Kanghom B was involved with data collection; Chaijitraruch N, Patcharatrakul T and Chongsrisawat V approved the final manuscript; Sintusek P designed and oversight of the study, involved with data collection, interpretation and analysis, draft and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institional Review Board of Chulalongkorn University, Thailand (IRB number 243/61).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrolment.
Conflict-of-interest statement: The authors of this manuscript having no conflict of interest to disclose.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, Assistant Professor, Department of Gastroenterology and Pediatric Liver Diseases and Immunology STAR (Special Task Force for Activating Research), Department of Pediatrics, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, No. 1873, Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: March 12, 2020
Peer-review started: March 12, 2020
First decision: April 25, 2020
Revised: April 30, 2020
Accepted: July 14, 2020
Article in press: July 14, 2020
Published online: July 28, 2020
ARTICLE HIGHLIGHTS
Research background
Esophageal atresia (EA) is a common digestive malformation with increasing risk of esophageal complications even after successful surgical correction. Gastroesophageal reflux disease (GERD) is the frequent gastrointestinal co-morbidity causing serious long-term consequences namely esophageal stricture and esophageal carcinoma. Hence, early detection and prompt treatment are crucial.
Research motivation
This research aimed to study the prevalence of GERD using esophageal histopathology and the novel tool, combined Video Multichannel Intraluminal Impedance and pH (MII-pH) study, in children diagnosed with EA. We believe that symptoms from video monitoring should be recorded more precisely with time reflux than by caregivers and make the interpretation of reflux-symptom association more meaningful.
Research objectives
To investigate the prevalence of GERD and the symptom association in children diagnosed EA by combined Video MII-pH study.
Research methods
Seventeen investigations that included esophagogastroduodenoscopy with biopsy and combined Video MII-pH study were performed in 15 children diagnosed EA. All signs and symptoms of GERD from video were recorded during MII-pH monitoring. MII-pH study was manually analysis including the symptom-reflux association using the symptoms from video record. Diagnostic value of combined Video MII-pH study was calculated using the result of esophageal histopathology as the gold standard to diagnose GERD.
Research results
The total symptoms recorded from video of all 17 combined Video MII-pH monitoring were cough (67.3%), vomiting (17.3%), irritability or unexplained crying (13.4%) and dysphagia (1.9%). In aspect of symptom association, vomiting was the symptom that mostly associated with reflux followed by irritability or unexplained crying and cough. Using esophageal histopathology as the gold standard for GERD, combined Video MII-pH has high diagnostic value with the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 72.7%, 100%, 100%, 67% and 82.4%, respectively.
Research conclusions
Prevalence of GERD in children with EA was high. Combined Video MII-pH study to detect GERD in children with EA had high diagnostic value with the trend of specific symptom association.
Research perspectives
MII-pH study has limitation to be the gold-standard test for GERD as the data of the reflux value in each age group are scarce. To improve the utility and diagnostic value of this machine, we synchronized the video recording during the study. The precise time of symptom recorded from video could increase symptom-reflux association albeit its time consuming. In the future, real-time Video MII-pH monitoring machine should be developed to improve the accuracy and clinical utility of MII-pH study.
