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Characterization of esophageal body and lower esophageal sphincter motor function in the very premature neonate

T I Omari1, M A Benninga, C P Barnett

  • 1Gastroenterology Unit, Women's and Children's Hospital, North Adelaide, Australia.

The Journal of Pediatrics
|October 13, 1999
PubMed

Insights

Very premature infants show well-developed esophageal motor function, with predominantly peristaltic waves. Transient lower esophageal sphincter relaxations (TLESRs) are identified as the primary cause of gastroesophageal reflux in these infants.

Area of Science:

  • Neonatal physiology
  • Gastrointestinal motility
  • Pediatric gastroenterology

Background:

  • Premature infants often experience feeding difficulties and gastroesophageal reflux.
  • Understanding esophageal motor function is crucial for managing these complications.

Purpose of the Study:

  • To characterize esophageal body and lower esophageal sphincter (LES) motor function in very premature infants.
  • To investigate the mechanisms underlying gastroesophageal reflux in this population.

Main Methods:

  • Esophageal manometry was performed in 12 very premature infants (26-33 weeks' postmenstrual age).
  • Motor patterns were recorded using a perfused micromanometric sleeve assembly.
  • Analysis focused on peristaltic sequences, LES pressure, and relaxation events.

Main Results:

  • Esophageal pressure waves were predominantly peristaltic (84%) in response to dry swallows.
  • All infants exhibited tonic LES contraction with varying resting pressures.
  • Pharyngeal swallows induced LES relaxation, while transient LES relaxations (TLESRs) occurred frequently (2.6 times/study).
  • 86% of TLESRs were associated with esophageal body common cavity events, indicative of reflux.

Conclusions:

  • Esophageal motor function, including peristalsis and LES response to swallows, is well-developed in very premature infants.
  • Transient LES relaxations (TLESRs) appear to be the predominant mechanism driving gastroesophageal reflux in this vulnerable group.
Abstract

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