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Gastroesophageal Reflux in Young Children Treated for Esophageal Atresia: Evaluation With pH-Multichannel Intraluminal Impedance

Catalano, Pieralba; Di Pace, Maria R; Caruso, Anna M; Casuccio, Alessandra; De Grazia, Enrico

Journal of Pediatric Gastroenterology and Nutrition: June 2011 - Volume 52 - Issue 6 - p 686–690
doi: 10.1097/MPG.0b013e318202a3e5
Original Articles: Gastroenterology

Objectives: Gastroesophageal reflux (GER) and dismotility occur frequently after repair of esophageal atresia (EA). GER-associated complications can manifest either early or later; then precocious diagnosis and treatment are essential. The aim of the study was to evaluate characteristics of GER and esophageal clearance in children treated for EA with distal tracheoesophageal fistula, using pH-multichannel intraluminal impedance (pH-MII).

Patients and Methods: Twenty-two children (ages 3–40 months) treated for EA at birth, and 20 normal children of similar age with suspected GER disease were included in the study. Impedance parameters were analyzed according to age and symptoms.

Results: Reflux events were mainly nonacidic. About bolus exposure index, mean acid clearing time (MACT), and mean bolus clearing time (MBCT), a significant difference was found between 2 groups: the median MACT and MBCT were longer, with values of 281 and 39 seconds, respectively, in the EA group and 110 and 15 seconds in the control group (P < 0.0005).

Conclusions: Our data show that in young patients the majority of refluxes are not acid. This implies that the incidence of GER may be underestimated if pH-metry is used. The pH-MII is an ideal test in children because it studies both GER with its characteristics and motility pattern. The quality of reflux does not seem to influence the onset of symptoms that are related to an impaired esophageal clearance. Hence, this technique could be useful to study patients treated for EA, avoiding the onset of complications.

Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Italy.

Received 10 September, 2009

Accepted 18 October, 2010

Address correspondence and reprint requests to Pieralba Catalano, Division of Pediatric Surgery, University of Palermo, Via Alfonso Giordano 3, Palermo, Italy (e-mail:

The authors report no conflicts of interests.

Copyright 2011 by ESPGHAN and NASPGHAN