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Esophageal motor dysfunction persists in children after surgical cure of reflux: an ambulatory manometric study
J Godoy1, J A Tovar, Y Vicente
1Department of Surgery, Hospital Infantil "La Paz," Universidad Autónoma, Madrid, Spain.
Insights
Esophageal dysmotility in children with gastroesophageal reflux (GER) persists after fundoplication surgery. This suggests that the observed motor dysfunction may be a primary condition rather than acquired.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Motility Disorders
- Gastroesophageal Reflux Disease (GERD)
Background:
- Gastroesophageal reflux (GER) in children can be associated with esophageal dysmotility.
- This dysmotility may be either a primary condition or acquired due to reflux.
Purpose of the Study:
- To investigate the nature of esophageal motor dysfunction in children with GER.
- To determine if this dysmotility improves following surgical correction of GER.
Main Methods:
- Combined ambulatory pH-metry and manometry were used in 16 children with reflux.
- Measurements were taken before and after successful fundoplication surgery.
- Paired statistical tests were employed to compare pre- and post-operative manometric and pH-metric variables.
Main Results:
- Fundoplication successfully resolved GER clinically and pH-metrically in all patients.
- Esophageal wave frequency decreased significantly post-surgery.
- Wave amplitude and duration remained unchanged; peristaltic wave proportion was normal and stable.
- Proportions of complete and effective esophageal waves remained low and did not improve after surgery.
Conclusions:
- Children with GER exhibit mild esophageal peristaltic disturbances, characterized by incomplete, weak, and ineffective waves.
- The persistence of esophageal dysmotility after successful fundoplication suggests a primary etiology.
- Surgical cure of GER does not appear to resolve the underlying esophageal motor dysfunction.
Background/Purpose:
Esophageal dysmotility shown by perfusion manometry in children with gastroesophageal reflux can be primary or acquired. This study examines by combined ambulatory pH-metry and manometry the nature of motor dysfunction and whether it improves after surgical cure of reflux.
Methods:
Sixteen refluxing children aged 131 +/- 54 months were studied by combined ambulatory pH-metry and manometry before and more than 6 months after successful fundoplication. pH-metric and manometric variables were compared at both time end-points by paired statistical tests accepting a significance level of P less than.05.
Results:
Operation cured all patients clinically and pH-metrically, but, in spite of this, only the frequency of motor sequences decreased significantly after the operation from 1 (0.45) to 0.8 (0.6) waves per minute (median [interquartile range]). Wave amplitude and duration were similar in both conditions; the proportion of peristaltic waves was normal and did not change before and after the operation (79.5% [17.25] v 81.4% [21.5]; not significant), whereas the proportions of complete (63.2% [17.5] v 67.8% [19.3]; not significant) and effective (32.4% [31.95] v 27.25% [22.5]; not significant) waves were definitely low and remained so after treatment.
Conclusions:
The esophagus of children with GER has mild disturbances of peristaltic activity with waves often incomplete, weak, and scarcely effective. Dismotility does not improve after successful fundoplication suggesting that it could be a primary phenomenon.