Detection of reflux-symptom association in children with esophageal atresia by video-pH-impedance study

Table 1 Symptoms and signs that may be associated with gastroesophageal reflux in infants and children[9]

Symptoms	Signs
General	General
Discomfort/irritability1	Dental erosion
Failure to thrive	Anemia
Feeding refusal
Dystonic neck posturing (Sandifer syndrome)
Gastrointestinal	Gastrointestinal
Recurrent regurgitation with/without	Esophagitis
vomiting in the older children	Esophageal stricture
Heartburn/chest pain2	Barrett esophagus
Epigastric pain2
Hematemesis
Dysphagia/odynophagia
Airway	Airway
Wheezing	Apnea spells
Stridor	Asthma
Cough	Recurrent pneumonia associated with aspiration
Hoarseness	Recurrent otitis media

¹If excessive irritability and pain is the single manifestation, it is unlikely to be related to gastroesophageal reflux disease.

²Typical symptoms of gastroesophageal reflux disease in older children.

Table 2 Patient demographic data and characteristics (n = 15)

Characteristics	Median (IQR) or n (%)
Male sex	6 (40)
Age (yr)	3.1 (2.2-9.8)
Weight for height (%)	100 (89.4-104.6)
Previous symptoms
General
Discomfort/ Irritability in infants	3
Failure to thrive or weight loss	8
Feeding refusal	3
Total	10 (66.7)
Gastrointestinal
Recurrent regurgitation with or without vomiting	9
Heartburn or chest pain	1
Epigastric pain	1
Hematemesis	1
Dysphagia, odynophagia	6
Total	11 (73.3)
Airway
Wheezing, stridor	4
Cough	9
Hoarseness	2
Total	10 (66.7)
Previous signs
General
Dental erosion	4
Anemia	2
Total	4 (26.7)
Gastrointestinal
Esophagitis	8
Esophageal stricture	7
Barret’s esophagus	2
Total	12 (80)
Airway
Asthma	1
Recurrent respiratory tract infection	8
Recurrent otitis media	2
Total	8 (53.3)

EA: Esophageal atresia; GER: Gastroesophageal reflux; IQR: Interquartile range.

Table 3 Esophagogastroduodenoscopy findings and biopsy results of children with esophageal atresia after esophageal anastomosis (n = 17)

Classification	n (%)
Los Angeles Classification
Normal1	8 (47.1)
A2	2 (11.8)
B3	4 (23.5)
C4	3 (17.6)
Pathology
Normal	6 (35.3)
Mild esophagitis	2 (11.8)
Severe esophagitis	9 (52.9)

¹One or more mucosal breaks confined to the mucosal folds, each not more than 5 mm in maximum length.

²One or more mucosal breaks more than 5 mm in maximum length, but not continuous between the tops of two mucosal folds.

³Mucosal breaks that are continuous between the tops of two or more mucosal folds, but which involve less than 75% of the esophageal circumference.

⁴Mucosal breaks which involve at least 75% of the esophageal circumference.

Table 4 Parameters used and the analysis result of combined multichannel intraluminal impedance and pH study in children diagnosed esophageal atresia after esophageal anastomosis (n = 17)

Parameters	Median (IQR)
Monitoring period excluding fed periods (h)	21.2 (19.3-22.1)
RI (%)	2.7 (0.5-9.5)
Longest reflux period (min)	20 (5-29)
Esophageal clearance (min)	1.4 (0.6-2.5)
Total reflux (times)	19 (11-36)
Acid	9 (4-14)
Weakly acid	10 (6-15)
Weakly alkaline	0 (0-0)
mean bolus clearance time (s)	14.9 (10.4-19.2)

RI: Reflux index.

Table 5 Parameters used and results from the analysis of combined Video Multichannel Intraluminal Impedance and pH study in children diagnosed esophageal atresia after esophageal anastomosis between using and non-using acid suppression therapy (n = 17)

Parameters	Acid suppression therapy (n = 7)	No acid suppression therapy (n = 10)	P value
Monitoring period (h)	21.2 (18.1-24.5)	21.3 (19.5-22.1)	0.696
RI (%)	7.1 (1.4-10)	1.45 (0.3-4.2)	0.24
Longest reflux period (min)	29 (5-96)	16 (4-24)	0.143
Esophageal clearance (min)	2.0 (1.0-3.6)	1.0 (0.5-1.7)	0.261
Total reflux (times)	19.0 (11-46)	19.0 (11-29)	0.66
Acid	10.0 (4-16)	6.5 (3-11)	0.558
Weakly acid	13.0 (4-32)	9.0 (6-14)	0.733
Weakly alkaline	0.0 (0-0)	0.0 (0-1)	0.123
Mean bolus clearance time (s)	11.9 (9.3-16.5)	17.3 (10.4-21.7)	0.242
Number of symptoms (times)	3.0 (1.0-5.0)	4.0 (1.0-7.0)	0.452
SI (%)	25 (0.0-50)	10.5 (0-66.7)	0.84
SSI (%)	1.4 (0-5.3)	3.7 (0.0-17.6)	0.419
SAP (%)	73.9 (0-90.9)	83.9 (0-99.1)	0.649

Present as median (IQR). RI: Reflux index; SAP: Symptom association probability; SI: Symptom index; SSI: Symptom sensitivity index.

Table 6 Symptoms and symptom correlation from video recording in children with esophageal atresia (n = 17)

Symptom	Symptoms	Symptom-refluxcorrelation	Acid	Weakly acid	Non acid	SI	SSI	SAP
Cough	35	16 (45.7)	9	7	0	58.5 (6.2-100)	2.9 (0.3-7.1)	95 (18.9-99.2)
Vomit	9	8 (89)	5	3	0	75 (50-100)	3.9 (2.3-60.7)	99.6 (87.8-99.9)
Irritability or unexplained crying	7	5 (71)	4	1	0	50 (25-50)	3.8 (2.5-3.8)	92.8 (72.9-92.8)
Dysphagia	1	0 (0)	0	0	0	0	0	0
Total	52	29 (55.7)	18	11	0	58.4 (27-100)	3.9 (1.3-7.1)	92.3 (77.4-99.6)

Present as n (%) or median (IQR). SI: Symptom index; SSI: Symptom sensitivity index; SAP: Symptom association probability.