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Eur J Pediatr Surg 2018; 28(06): 502-507
DOI: 10.1055/s-0037-1607290
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Follow-up of Congenital Diaphragmatic Hernia: Need for Routinary Assessment of Acid Gastroesophageal Reflux with pH-metry

Andrea Zanini
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Francesco Macchini
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Giorgio Farris
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Anna Morandi
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Irene Festa
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Giulia Brisighelli
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Valerio Gentilino
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Ernesto Leva
1   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
› Author Affiliations Funding None.
Further Information

Publication History

11 May 2017

05 September 2017

Publication Date:
11 October 2017 (online)

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Abstract

Introduction We aim to assess gastroesophageal reflux (GER) in patients treated for congenital diaphragmatic hernia (CDH) and to determine whether a pH-metry investigation should be routinely performed in follow-up.

Materials and Methods Twenty-four-hour pH-metry at 1 year was performed in all patients treated for CDH between January 2014 and April 2015 (Group 1). We compared pH-metry results to those of two other groups: children treated for esophageal atresia (EA) (Group 2) and normal babies presenting with typical symptoms (Group 3). All the pH-metric findings were analyzed and compared. Intra-group analysis was performed in Group 1.

Results Group 1 consisted of 21, Group 2 of 24, and Group 3 of 21 patients. Mean pH-metry values for Groups 1, 2, and 3 were, respectively: reflux index (RI) 4.3, 5.1, and 3.9; total number of refluxes (NR) 79.5, 88.8, and 88.7; refluxes longer than 5′ (R > 5) 1.7, 2.3, and 1.47; and longest reflux episode (LR) 11.4, 13.3, and 8.6. No significant differences were found between Group 1 and the others. Only two CDH patients presented with GER-related symptoms. Patch was associated with significantly higher RI (8.5 vs. 2.98, p = 0.03). The worse was the defect, the worse were the pH-metric results (RI: A3.09, B3.15, and C9.1).

Conclusion We believe that a routine GER assessment should be performed in all CDH patients regardless the presence of symptoms.

Level of Evidence This is a Level II study.

Keywords

congenital diaphragmatic hernia - gastroesophageal reflux - pH-metry - esophageal atresia - follow-up
 

  • References

  • 1 Mielniczuk M, Kusza K, Brzeziński P, Jakubczyk M, Mielniczuk K, Czerwionka-Szaflarska M. Current management of congenital diaphragmatic hernia. Anaesthesiol Intensive Ther 2012; 44 (04) 232-237
    PubMedGoogle Scholar
  • 2 Tovar JA. Congenital diaphragmatic hernia. Orphanet J Rare Dis 2012; 7 (03) 1
    CrossrefPubMedGoogle Scholar
  • 3 Koivusalo AI, Pakarinen MP, Lindahl HG, Rintala RJ. The cumulative incidence of significant gastroesophageal reflux in patients with congenital diaphragmatic hernia-a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg 2008; 43 (02) 279-282
    CrossrefPubMedGoogle Scholar
  • 4 Lally KP, Engle W. ; American Academy of Pediatrics Section on Surgery; American Academy of Pediatrics Committee on Fetus and Newborn. Postdischarge follow-up of infants with congenital diaphragmatic hernia. Pediatrics 2008; 121 (03) 627-632
    CrossrefPubMedGoogle Scholar
  • 5 Vanamo K, Rintala RJ, Lindahl H, Louhimo I. Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects. J Pediatr Surg 1996; 31 (04) 551-554
    CrossrefPubMedGoogle Scholar
  • 6 Steven MJ, Fyfe AH, Raine PA, Watt I. Esophageal adenocarcinoma: a long-term complication of congenital diaphragmatic hernia?. J Pediatr Surg 2007; 42 (07) E1-E3
    PubMedGoogle Scholar
  • 7 Morandi A, Macchini F, Zanini A. , et al. Endoscopic surveillance for congenital diaphragmatic hernia: unexpected prevalence of silent esophagitis. Eur J Pediatr Surg 2016; 26 (03) 291-295
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007; 2: 24
    CrossrefPubMedGoogle Scholar
  • 9 Shawyer AC, D'Souza J, Pemberton J, Flageole H. The management of postoperative reflux in congenital esophageal atresia-tracheoesophageal fistula: a systematic review. Pediatr Surg Int 2014; 30 (10) 987-996
    CrossrefPubMedGoogle Scholar
  • 10 Pedersen RN, Markøw S, Kruse-Andersen S. , et al. Esophageal atresia: gastroesophageal functional follow-up in 5–15 year old children. J Pediatr Surg 2013; 48 (12) 2487-2495
    CrossrefPubMedGoogle Scholar
  • 11 Krishnan U, Mousa H, Dall'Oglio L. , et al. ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. J Pediatr Gastroenterol Nutr 2016; 63 (05) 550-570
    CrossrefPubMedGoogle Scholar
  • 12 Vandenplas Y, Rudolph CD, Di Lorenzo C. , et al; North American Society for Pediatric Gastroenterology Hepatology and Nutrition; European Society for Pediatric Gastroenterology Hepatology and Nutrition. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49 (04) 498-547
    CrossrefPubMedGoogle Scholar
  • 13 Lally KP, Lasky RE, Lally PA. , et al; Congenital Diaphragmatic Hernia Study Group. Standardized reporting for congenital diaphragmatic hernia--an international consensus. J Pediatr Surg 2013; 48 (12) 2408-2415
    CrossrefPubMedGoogle Scholar
  • 14 Bagolan P, Morini F. Long-term follow up of infants with congenital diaphragmatic hernia. Semin Pediatr Surg 2007; 16 (02) 134-144
    CrossrefPubMedGoogle Scholar
  • 15 Koivusalo A, Pakarinen MP, Rintala RJ. Anastomotic dilatation after repair of esophageal atresia with distal fistula. Comparison of results after routine versus selective dilatation. Dis Esophagus 2009; 22 (02) 190-194
    CrossrefPubMedGoogle Scholar
  • 16 Parolini F, Leva E, Morandi A. , et al. Anastomotic strictures and endoscopic dilatations following esophageal atresia repair. Pediatr Surg Int 2013; 29 (06) 601-605
    CrossrefPubMedGoogle Scholar
  • 17 Lang T, Hümmer HP, Behrens R. Balloon dilation is preferable to bougienage in children with esophageal atresia. Endoscopy 2001; 33 (04) 329-335
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope?. Eur J Pediatr Surg 2012; 22 (02) 109-116
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Baird R, Laberge JM, Lévesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg 2013; 23 (03) 204-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Peetsold MG, Kneepkens CM, Heij HA, IJsselstijn H, Tibboel D, Gemke RJ. Congenital diaphragmatic hernia: long-term risk of gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2010; 51 (04) 448-453
    CrossrefPubMedGoogle Scholar
  • 21 Vandenplas Y. Challenges in the diagnosis of gastroesophageal reflux disease in infants and children. Expert Opin Med Diagn 2013; 7 (03) 289-298
    CrossrefPubMedGoogle Scholar
  • 22 Stolar CJ, Levy JP, Dillon PW, Reyes C, Belamarich P, Berdon WE. Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia. Am J Surg 1990; 159 (02) 204-207
    CrossrefPubMedGoogle Scholar
  • 23 Laviola M, Zanini A, Priori R. , et al. Thoraco-abdominal asymmetry and asynchrony in congenital diaphragmatic hernia. Pediatr Pulmonol 2015; 50 (09) 915-924
    CrossrefPubMedGoogle Scholar
  • 24 Kieffer J, Sapin E, Berg A, Beaudoin S, Bargy F, Helardot PG. Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 1995; 30 (09) 1330-1333
    CrossrefPubMedGoogle Scholar
  • 25 Harting MT, Lally KP. The Congenital Diaphragmatic Hernia Study Group registry update. Semin Fetal Neonatal Med 2014; 19 (06) 370-375
    CrossrefPubMedGoogle Scholar
  • 26 Di Pace MR, Caruso AM, Farina F, Casuccio A, Cimador M, De Grazia E. Evaluation of esophageal motility and reflux in children treated for congenital diaphragmatic hernia with the use of combined multichannel intraluminal impedance and pH monitoring. J Pediatr Surg 2011; 46 (10) 1881-1886
    CrossrefPubMedGoogle Scholar