Bergmeijer, Jan-Hein L. J.; Bouquet, Jan; Hazebroek, Frans W. J. Normal Ranges of 24-Hour pH-metry Established in Corrected Esophageal Atresia // Journal of Pediatric Gastroenterology & Nutrition:Volume 28(2) – February. – 1999. – pp 162–163.
Normal Ranges of 24-Hour pH-metry Established in Corrected Esophageal AtresiaBergmeijer, Jan-Hein L. J.; Bouquet, Jan*; Hazebroek, Frans W. J.
Children who have undergone successful correction of esophageal atresia often have gastroesophageal reflux, which, in turn, is a major cause of complications, such as anastomotic stricture, reflux esophagitis, aspiration pneumonia, and even near-sudden infant death syndrome (1-3).
The decision whether surgical or medical treatment or no treatment at all is indicated should be applied on suspicion of reflux and must be based not only on good clinical grounds, but on objective investigations as well. Barium contrast study of the esophagus and stomach, esophagoscopy, and 24-hour pH-metry are the standard methods for the diagnosis and evaluation of pathologic gastroesophageal reflux in normal neonates and children. Even more strongly, pH-metry is considered the gold standard for defining the duration and severity of reflux (4-7). Normal ranges have been established for these groups (8,9), but not for patients with corrected esophageal atresia.
For this reason, we investigated 24-hour pH-metry values measured early after operation in 13 patients whose postoperative course during the first year after correction of esophageal atresia was completely uneventful.
PATIENTS AND METHODS
From January 1994 through November 1996, 48 patients with esophageal atresia were treated in the Sophia Children's Hospital. According to the criteria of Gross, three patients had type A atresia, and underwent colonic interposition. Two patients had H-type fistula and the other 43 had classic type C with tracheoesophageal-fistula. In accordance with our treatment protocol, they all underwent pH-metry studies between 8 and 16 weeks after surgery. Twenty-four patients had reflux-associated complications, such as failure to thrive, stricture of the anastomosis, respiratory tract infections, or tracheal malacia. All underwent prolonged medical antireflux therapy, and eight of them underwent a Nissen fundoplication.
Of the remaining 19 patients with an uncomplicated short- and long-term postoperative course, followed up for at least 1 year, 13 had undergone a complete and reliable 24-hour pH-metry without medication. In four of the remaining six patients, pH-metry was performed much later than 16 weeks after surgery, and consent for the investigation was refused by the parents of the two remaining patients. The pH-metries had been performed in our hospital, using a flexible glass electrode with internal reference electrode (Escolab, Maarssenbroek, The Netherlands) connected to a bedside computing system (UPS-2020/Orion, MMS B.V. Holland, Enschede, The Netherlands). All patients were fed their normal formulas during pH-monitoring.
The mean gestational age of the 7 girls and 6 boys was 36 weeks (range, 31-40 weeks). Six patients had been born at term, and 7 were premature. Only 2 of the 13 patients showed (minor) anastomotic tension, and only 1 had minor leakage of the anastomosis. All patients were supported by postoperative ventilation, which we consider essential after a major thoracotomy. Ten patients were ventilated for 2 to 5 days, and 3 premature infants for 22, 28, and 60 days. In all but 1 patient, the site of the esophagogastric junction as assessed by a barium contrast study was normal, although all children had some provocative reflux, which we did not consider to be abnormal.
The pH-metries were performed at a mean of 12.7 weeks (range, 8-16 weeks; median, 12 weeks) after surgery. The mean reflux index (percentage of time with pH <4 during 24 hours) was 4.08% (range, 1-9.8%; median, 3.3%). Mean total number of reflux periods with a pH less than 4 was 21 (range, 3-60; median, 17). Mean number of periods of pH less than 4 lasting longer than 5 minutes was 2.5 (range, 0-9; median, 2). Figure 1 shows the correlation between gestational age of the patients and the reflux index.
FIG. 1. Relation between reflux index values and gestational age
Назад в раздел
Популярно о болезнях ЖКТ читайте в разделе "Пациентам"
Информация на сайте www.gastroscan.ru предназначена для образовательных и научных целей. Условия использования.