Clinical variables as indicative factors for endoscopy in adolescents with esophageal atresia

Audun Mikkelsen*, Unn Inger Møinichen, Henrik Mikael Reims, Krzysztof Grzyb, Lars Aabakken, Lars Mørkrid, Hanneke IJsselstijn, Ragnhild Emblem

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Introduction: Gastro-esophageal reflux disease (GERD) occurs frequently in patients operated for esophageal atresia (EA). Longstanding esophagitis may lead to dysphagia, strictures, columnar metaplasia, and dysplasia with an increased risk of adenocarcinoma. Are clinical factors and non-invasive assessments reliable indicators for follow-up with endoscopy? Material and method: A follow-up study with inclusion of EA adolescents in Norway born between 1996 and 2002 was conducted. Clinical assessment with pH monitoring, endoscopy with biopsies, along with interviews and questionnaires regarding gastroesophageal reflux disease (GERD) and dysphagia were performed. Results: We examined 68 EA adolescents. 62% reported GERD by interview, 22% by questionnaire. 85% reported dysphagia by interview, 71% by questionnaire. 24-hour pH monitoring detected pathological reflux index (RI) (>7%) in 7/59 (12%). By endoscopy with biopsy 62 (92%) had histologic esophagitis, of whom 3 (4%) had severe esophagitis. Gastric metaplasia was diagnosed in twelve (18%) adolescents, intestinal metaplasia in only one (1.5%). None had dysplasia or carcinoma. Dysphagia and GERD were statistically correlated to esophagitis and metaplasia, but none of the questionnaires or interviews alone were good screening instruments with high combined sensitivity and specificity. A compound variable made by simply taking the mean of rescaled RI and dysphagia by interview showed to be the best predictor of metaplasia (85% sensitivity, 67% specificity). Conclusion: The questionnaires and interviews used in the present study were not good screening instruments alone. However, combining dysphagia score by interview and RI may be helpful in assessing which patients need endoscopy with biopsy at each individual follow-up examination.

Original languageEnglish
Pages (from-to)1421-1429
Number of pages9
JournalJournal of Pediatric Surgery
Issue number8
Early online date18 Oct 2022
Publication statusPublished - Aug 2023

Bibliographical note

This research is generated within the European Reference Network for rare Inherited and Congenital Anomalies (ERNICA) - Project ID No 739544 (not financially supported).

Publisher Copyright: © 2022 The Authors


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