Predictors of histopathological esophagitis in infants and adolescents with esophageal atresia within a national follow-up programme.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Esophageal Atresia* ; Esophagitis*/diagnosis ; Esophagitis*/epidemiology ; Esophagitis, Peptic*/epidemiology ; Gastroesophageal Reflux*/diagnosis ; Hernia, Hiatal*/epidemiology; Adolescent ; Cross-Sectional Studies ; Follow-Up Studies ; Gastroscopy ; Humans ; Infant ; Quality of Life

Purpose: Esophageal atresia (EA) is a congenital anomaly of the foregut. Although the survival has improved over the years there is a significant gastrointestinal morbidity affecting physical function and health-related quality of life. The aims of the study were to identify and evaluate predictors of histopathological esophagitis in infants and adolescents with EA.
Methods: Single centre, cross-sectional study including one and 15-year-old patients operated for EA that participated in the national follow-up programme between 2012 and 2020 according to a pre-established protocol including upper endoscopy with oesophageal biopsies and 24h-pH-test. Data was collected from patients' medical records and pH-analysis software. Regression models were used to identify predictors of histopathological oesophagitis. Possible predictors were abnormal reflux index, endoscopic esophagitis, hiatal hernia, symptoms of gastroesophageal reflux (GER) and age.
Results: 65 patients were included, 47 children and 18 adolescents. All children were treated with PPI during their first year of life. Symptoms of GER were reported by 13 (31.7%) of the infant's caregivers, 34 of the children (72.3%) had abnormal reflux index and 32 (68.1%) had histopathological esophagitis. The corresponding numbers for adolescents were 8 (50%), 15 (83.3%) and 10 (55.6%). We found no significant associations between histopathological esophagitis and endoscopic esophagitis, symptoms of GER, hiatus hernia or age group. Abnormal reflux index was an independent predictor of histopathological esophagitis. Seven patients with normal reflux index had histopathological esophagitis, all grade I.
Conclusions: We found a high prevalence of histopathological esophagitis despite PPI treatment in accordance with recommendations. No significant difference between the two age groups was seen. Abnormal reflux index was an independent predictor of histopathological esophagitis. However, we cannot recommend the use of pH-metry as a substitute for esophageal biopsies; future studies are needed to elucidate if esophageal biopsies might be postponed in infants with normal reflux index.
Competing Interests: The authors have declared that no competing interests exist.

J Pediatr Surg. 1997 Nov;32(11):1580-6. (PMID: 9396530)
World J Gastroenterol. 2018 Mar 7;24(9):1056-1062. (PMID: 29531469)
Pediatr Surg Int. 2008 May;24(5):531-6. (PMID: 18351365)
J Pediatr Surg. 2013 Dec;48(12):2487-95. (PMID: 24314192)
J Pediatr Surg. 2005 Feb;40(2):307-12. (PMID: 15750920)
Eur J Pediatr Surg. 2011 Mar;21(2):94-8. (PMID: 21283959)
Eur J Pediatr Surg. 2013 Aug;23(4):273-5. (PMID: 23172565)
Bull World Health Organ. 2007 Sep;85(9):660-7. (PMID: 18026621)
Br J Surg. 1996 Sep;83(9):1268-70. (PMID: 8983626)
J Pediatr Surg. 2007 Aug;42(8):1433-8. (PMID: 17706510)
Pediatr Surg Int. 2011 Nov;27(11):1141-9. (PMID: 21960312)
Pediatr Surg Int. 1999;15(1):8-10. (PMID: 9914345)
Eur J Pediatr Surg. 2019 Dec;29(6):510-515. (PMID: 30566986)
Pediatrics. 2012 Sep;130(3):e476-85. (PMID: 22908104)
J Pediatr Surg. 2016 Sep;51(9):1421-5. (PMID: 27114309)
Am J Roentgenol Radium Ther Nucl Med. 1961 Nov;86:884-7. (PMID: 14456320)
Dig Liver Dis. 2015 Dec;47(12):1027-32. (PMID: 26362613)
Pediatr Surg Int. 2012 Mar;28(3):249-57. (PMID: 22020495)
BMC Pediatr. 2013 Apr 20;13:59. (PMID: 23601190)
J Pediatr Gastroenterol Nutr. 2016 Apr;62(4):562-6. (PMID: 26348684)
J Pediatr Gastroenterol Nutr. 2016 Nov;63(5):550-570. (PMID: 27579697)
J Pediatr Surg. 1980 Feb;15(1):74-8. (PMID: 7365661)
Can J Gastroenterol. 2010 May;24(5):312-6. (PMID: 20485706)
Arch Dis Child. 2012 Sep;97(9):808-11. (PMID: 22753768)
J Pediatr Surg. 2013 Dec;48(12):2496-505. (PMID: 24314193)
Pediatrics. 2011 Nov;128(5):e1053-61. (PMID: 21969289)
Am J Surg Pathol. 2007 May;31(5):706-10. (PMID: 17460453)
J Pediatr Gastroenterol Nutr. 2019 Aug;69(2):163-170. (PMID: 30921254)
J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):686-90. (PMID: 21597403)
J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):515-522. (PMID: 31490855)
Pediatr Surg Int. 1997;12(8):552-5. (PMID: 9354724)
J Neurosurg Anesthesiol. 2009 Oct;21(4):286-91. (PMID: 19955889)
J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):45-51. (PMID: 30889131)
Acta Paediatr. 2010 Mar;99(3):411-7. (PMID: 19912137)
BMC Pediatr. 2014 Feb 03;14:32. (PMID: 24490896)
Ann Surg. 2010 Jun;251(6):1167-73. (PMID: 20485152)
Anesth Analg. 2011 Nov;113(5):1143-51. (PMID: 21415431)
Gastroenterology. 1970 Feb;58(2):163-74. (PMID: 5413015)
J Pediatr Surg. 1998 Mar;33(3):476-80. (PMID: 9537560)
Anesthesiology. 2009 Apr;110(4):796-804. (PMID: 19293700)
J Pediatr Surg. 2003 May;38(5):702-4. (PMID: 12720174)
Eur J Pediatr Surg. 2017 Apr;27(2):192-195. (PMID: 27214095)
Eur J Pediatr Surg. 2017 Feb;27(1):50-55. (PMID: 27769086)
World J Surg. 2007 Jul;31(7):1512-7. (PMID: 17534555)
Public Health Nutr. 2006 Oct;9(7):942-7. (PMID: 17010261)
Eur J Pediatr Surg. 2020 Dec;30(6):475-482. (PMID: 31777030)

Date Created: 20220415 Date Completed: 20220419 Latest Revision: 20231103

20240829

PMC9012387

10.1371/journal.pone.0266995

35427378