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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2017

Open Access 01-07-2017

Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease

Authors: Femke A. Mauritz, Nicolaas F. Rinsma, Ernest L. W. van Heurn, Cornelius E. J. Sloots, Peter D. Siersema, Roderick H. J. Houwen, David C. van der Zee, Ad A. M. Masclee, José M. Conchillo, Maud Y. A. Van Herwaarden-Lindeboom

Published in: Surgical Endoscopy | Issue 7/2017

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Abstract

Background

Esophageal intraluminal baseline impedance reflects the conductivity of the esophageal mucosa and may be an instrument for in vivo evaluation of mucosal integrity in children with gastroesophageal reflux disease (GERD). Laparoscopic antireflux surgery (LARS) is a well-established treatment option for children with proton pump inhibitory (PPI) therapy resistant GERD. The effect of LARS in children on baseline impedance has not been studied in detail. The aim of this study was to evaluate the effect of LARS on baseline impedance in children with GERD.

Methods

This is a prospective, multicenter, nationwide cohort study (Dutch national trial registry: NTR2934) including 25 patients [12 males, median age 6 (range 2–18) years] with PPI-resistant GERD scheduled to undergo LARS. Twenty-four hour multichannel intraluminal impedance pH monitoring (MII-pH monitoring) was performed before and 3 months after LARS. Baseline impedance was evaluated during consecutive 2-h intervals in the 24-h tracings.

Results

LARS reduced acid exposure time from 8.5 % (6.0–16.2 %) to 0.8 % (0.2–2.8 %), p < 0.001. Distal baseline impedance increased after LARS from 2445 Ω (1147–3277 Ω) to 3792 Ω (3087–4700 Ω), p < 0.001. Preoperative baseline impedance strongly correlated with acid exposure time (r −0.76, p < 0.001); however, no association between symptomatic outcome and baseline impedance was identified.

Conclusions

LARS significantly increased baseline impedance likely reflecting recovery of mucosal integrity. As the change in baseline impedance was not associated with the clinical outcome of LARS, other factors besides mucosal integrity may contribute to symptom perception in children with GERD.
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Metadata
Title
Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease
Authors
Femke A. Mauritz
Nicolaas F. Rinsma
Ernest L. W. van Heurn
Cornelius E. J. Sloots
Peter D. Siersema
Roderick H. J. Houwen
David C. van der Zee
Ad A. M. Masclee
José M. Conchillo
Maud Y. A. Van Herwaarden-Lindeboom
Publication date
01-07-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5304-0

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