Evaluation of Gastroesophageal Reflux in Children Born with Esophageal Atresia Using pH and Impedance Monitoring

Objectives To evaluate acid and non-acid gastroesophageal reflux in infants and school-aged children with esophageal atresia (EA) using pH-impedance (pH-MII) monitoring. Methods Between 2012-2017, all 24-hour pH-MII studies performed in infants (≥18 months) and 8-year olds with EA were included. Anti-acid therapy was discontinued before study. Exclusion criteria were: isolated tracheoesophageal fistula; esophageal replacement therapy; tube feeding; and monitoring <18 hours. Automatically detected retrograde bolus movements (RBM) were manually reviewed and modified/deleted if necessary. Results We included 57 children (51% male; 2% isolated EA; 44% thoracoscopic EA repair): 24 infants (median age 0.6 years) and 33 school-aged children (median age 8.2 years). Of the automatically detected 3,313 RBM, 1,292 were manually deleted from the tracings: 52% of non-acid RBM and 8% of acid RBM (mainly misinterpreted swallows or one event recognized as several events). In infants, median reflux index (RI;pH<4) was 2.6% (abnormal in n=2), median RBM was 61 (62% non-acid, 58% mixed) and median of the mean BCT was 11 seconds. In older children, median RI was 0.3% (abnormal in n=4), median RBM was 21 (64% non-acid; 75% mixed) and median of the mean BCT was 13 seconds. Conclusions Most children with EA off medication have a normal RI, yet experience a significant number of non-acid RBM. After manual revision of the tracings a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA and question the need for standard antiacid therapy in these patients.