Evaluation of esophageal motility and reflux in children treated for congenital diaphragmatic hernia with the use of combined multichannel intraluminal impedance and pH monitoring.
BACKGROUND
Gastroesophageal reflux (GER) is frequently observed in children treated for congenital diaphragmatic hernia (CDH) at birth, as well as esophageal dysmotility, that has been hypothesized to be caused by innervatory anomalies. The aim of this study is to evaluate GER and dysmotility in young patients with CDH using pH-multichannel intraluminal impedance.


METHODS
Thirty children (17 boys and 13 girls) who underwent repair for CDH between 2002 and 2007 with a median age of 5.2 years (range, 3-10 years) were included in the study. All patients were operated on with a subcostal laparotomy incision and had a left-sided diaphragmatic defect. The defect repair required an artificial patch (Goretex, Gore Medical, Flagstaff, AZ) in 8 patients (27%) because of its size. We described impedance reflux parameters and some specific motility parameters studied on 10 standardized swallows.


RESULTS
The incidence of GER was 86%. Reflux was mainly nonacidic, postprandial, and short-term and reached only the distal esophagus. Esophageal dysmotility was observed only in the distal esophagus.


CONCLUSIONS
With the use of pH-multichannel intraluminal impedance, both GER and esophageal motility in patients with congenital malformations can be analyzed. In patients with CDH, impaired motility seems to involve only the distal esophagus. In this group, the specific pattern of reflux is probably caused by the involvement of gastroesophageal junction, without significant intrinsic innervation abnormalities as observed in patients with esophageal atresia.
Department of Mother and Child Care, Pediatric Surgical Unit, University of Palermo, Palermo 90100, Italy.
Maria Rita
MR
Di Pace
Anna Maria
AM
Caruso
Fabiana
F
Farina
Alessandra
A
Casuccio
Marcello
M
Cimador
Enrico
E
De Grazia
D002648:Child; D002675:Child, Preschool; D003679:Deglutition / Q000502:physiology; D017097:Electric Impedance; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome