Postoperative evaluation of esophageal atresia: consistency between multichannel intraluminal impedance pH measurements and endoscopic findings

Gastroesophageal reflux disease is the most frequent gastrointestinal complication of surgical repair of esophageal atresia (EA). To date, we have reported the significance of assessing the waveform pattern in multichannel intraluminal impedance-pH (MII-pH) for esophageal diseases. This study aimed to assess the relevance of MII-pH and endoscopic findings in EA. The study population of this retrospective study included 22 EA patients (median age: 3.0 years, interquartile 2-5 years) in whom MII-pH was conducted. Low baseline impedance values have been detected in patients with esophagitis and esophageal motility disorders. In the MII-pH study, low impedance influenced the difficulty of the analysis. We classified MII-pH waveforms according to the difficulty of analysis as either easy-to-analyze waveforms or difficult-to-analyze waveforms. With regard to waveform pattern, pH index, bolus exposure index, total reflux episodes, total proximal episodes, and acid proximal episodes in patients with difficult-to-analyze waveforms were significantly higher than in patients with easy-to-analyze waveforms. In addition, the baseline impedance values of distal esophagus in patients with difficult-to-analyze waveforms were significantly lower than in patients with easy-to-analyze waveforms. Four patients (26.7%) with a pH index ≥3.0% were diagnosed with nonerosive reflux disease. Endoscopic findings showed no erosions in EA patients with easy-to-analyze waveforms. Three patients with type A EA were difficult-to-analyze waveforms. The present study demonstrated that MII-pH is useful for evaluating EA. In particular, MII-pH can be used to detect nonerosive reflux disease. Evaluation of the waveform could be an indication for endoscopy.