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

Abstract

BackgroundEsophageal 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.MethodsThis 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.ResultsLARS 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.ConclusionsLARS 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.

Alternative therapies for GERD: a way to personalized antireflux surgery

“…Going in line with this notion, a recent study found that elimination of the reflux after effective fundoplication is more effective to restore the electrical resistance of the esophagus. 11 Taken together, the above studies show that electrical resistance serves as a sensitive measure to monitor the integrity of the esophageal epithelium before and after medical or surgical therapy of GERD and BE. [7][8][9][10][11] Conceptually, GERD results from a refluxinduced orchestration of an inflammatory response, involving epithelial, nerve, inflammatory, and muscle cells within the esophageal mucosa 4-6 ( Fig.…”

“…Since patients receive high‐dose PPI therapy after RFA, these resistance differences between normal and neo‐squamous epithelium are suggested to be attributed to the lack of elimination of the reflux per se. Going in line with this notion, a recent study found that elimination of the reflux after effective fundoplication is more effective to restore the electrical resistance of the esophagus …”

“…Taken together, the above studies show that electrical resistance serves as a sensitive measure to monitor the integrity of the esophageal epithelium before and after medical or surgical therapy of GERD and BE . Conceptually, GERD results from a reflux‐induced orchestration of an inflammatory response, involving epithelial, nerve, inflammatory, and muscle cells within the esophageal mucosa (Fig.…”

Current Issues of GERD Surgical Treatment in Children

“…Authors Moritz A. F., Rinsma N. F., and Ernest L. V. studied the effect of laparoscopic antireflux surgery on the initial impedance as a reflection of the integrity of the mucosa in 25 children with gastroesophageal reflux disease and concluded that surgical antireflux protection performed laparoscopically reduces the time of acid exposure from 8.5% (6.0%–16.2%) to 0.8% (0.2%–2.8%), P < 0.001, respectively, increases the distal resistance, resulting in restoration of the base impedance, reduction of reflux symptoms, and restoration of the integrity of the esophageal mucosa. [ 9 ]…”

Some Data on Surgical Treatment of Gastroesophageal Reflux

“…Laparoscopic antireflux surgery significantly increased baseline impedance likely reflecting recovery of mucosal integrity [10]. Duration of stay is an important clue in our discussion that we touched a little on discussingat the above problem of laparoscopic cost operators.…”