title: Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula.
abstract: BACKGROUND
  Motility disturbances of the esophagus and gastroesophageal reflux disease (GERD) are observed frequently in children after repair of congenital esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Recently, in many pediatric surgical centers, thoracoscopic repair was introduced, which theoretically would change the postoperative course.
  
  
  OBJECTIVE
  The goal of the study was to assess physical development, disease symptoms, and GERD symptom frequency in children who underwent thoracoscopic surgery of congenital EA/TEF.
  
  
  METHODS
  The study comprised 22 children (14 boys and 8 girls), aged 16 to 79 months (average age 47.3 months) after surgery of EA/TEF. Clinical symptoms and physical development were analyzed. In 19 children, multichannel intraluminal esophageal impedance connected with pH-metry (MII/pH) was performed. In 11 patients, esophagogastroduodenoscopy with a histological study of mucosa samples was done.
  
  
  RESULTS
  The most frequent symptoms were dysphagia, belching, cough and recurrent bronchitis. In 31.5% of the children, body mass deficiency was observed and in 28.6%, low body mass and short stature. Prematurity was present in half of the patients. Depending on the result of the MII/pH study, the children were divided into two groups: 10 children with GERD and 9 children without diagnosis of gastroesophageal reflux. In the 10 with GERD, acid reflux was diagnosed in 9 and non-acid reflux was diagnosed in one. MII/pH demonstrated statistically significant differences in the number of reflux episodes, reflux index, bolus exposure index, mean time of esophageal exposure and acid exposure and mean acid clearance time in children with GERD in comparison to children without this disease. In 36.4% of children who underwent endoscopy, esophagitis was diagnosed, esophageal stricture in 18% and gastric metaplasia in 9.1%.
  
  
  CONCLUSIONS
  In children who underwent corrective thoracoscopic surgery of EA/TEF, GERD caused by motility disorders of the esophagus was frequently observed. These children require constant monitoring and early treatment of the complication.
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Iwańczak
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kosmowska-Miśków
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kofla-Dłubacz
authors.affiliation: Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Palczewski
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Grabiński
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Pawłowska
authors.affiliation: Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Matusiewicz
authors.affiliation: Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Patkowski
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D004933:Esophageal Atresia / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D013906:Thoracoscopy; D014138:Tracheoesophageal Fistula / Q000378:metabolism* / Q000601:surgery*; D014945:Wound Healing
keywords: MII/pH; esophageal atresia; gastroesophageal reflux disease; thoracoscopy; tracheoesophageal fistula