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[Clinical study on abnormalities of lower esophageal sphincter (LES) function in infancy and childhood with special
1Department of Pediatric Surgery, Numazu Municipal Hospital.
Insights
Lower esophageal sphincter (LES) pressure is significantly lower in infants with gastroesophageal reflux (GER). LES pressure improves with clinical healing, indicating its role in antireflux competence.
Area of Science:
- Gastroenterology
- Pediatric Physiology
- Diagnostic Medicine
Context:
- Gastroesophageal reflux (GER) is common in infants, impacting their well-being.
- Assessing the lower esophageal sphincter (LES) function is crucial for understanding antireflux competence.
- Standardized manometric studies, barium studies, and 24-hour pH monitoring are key diagnostic tools.
Purpose:
- To clarify the role of lower esophageal sphincter (LES) function in infant antireflux competence.
- To compare LES function between normal infants and those with GER.
- To evaluate the utility of various diagnostic methods in assessing LES dysfunction.
Summary:
- Lower esophageal sphincter (LES) pressure was significantly lower in infants with GER (22.2 cmH2O) compared to normal infants (37.6 cmH2O).
- LES pressure in GER infants increased to normal levels with clinical improvement, with a critical threshold identified at 27 cmH2O.
- Radiological studies showed no correlation between barium regurgitation grade and LES pressure, while 24-hour pH monitoring confirmed LES incompetence in GER infants.
Impact:
- Esophageal manometric studies are highly effective for diagnosing LES dysfunction and monitoring therapeutic effects in infants.
- A multi-approach evaluation, including manometry, radiology, and pH monitoring, provides comprehensive assessment of anti-reflux function.
- Findings contribute to a better understanding of GER pathophysiology and management strategies in infants.
Abstract:
For the purpose of clarifying lower esophageal sphincter function, which is representative of antireflux competence, 51 normal newborn and early infants and 28 newborn and infants with gastroesophageal reflux were examined by standardized manometric studies. Barium studies and 24-hour pH monitoring in the distal esophagus were also performed, and the following results were obtained. 1) In normal infants, there was no correlation between LES pressure and age, but LES length increased with age. 2) LES Pressure of GER infants (22.2 +/- 6.4 cmH2O) was lower than normal infants (37.6 +/- 8.8 cmH2O). This indicated LES function was lower in GER infants. 3) In GER infants, LES pressure increased to within normal range with clinical improvement. The critical point of LES pressure was 27 cmH2O. 4) In radiological studies in GER infants there was no correlation between the grade of Barium regurgitation and LES pressure, or between HIS angle, Fornix Index and LES pressure. 5) On 24-hour pH monitoring, pH score of GER infants was very much higher than that of normal infants. LES incompetence din GER infants was also recognized in this investigation. Esophageal manometric study was very useful for diagnosis of LES dysfunction and assessment of therapeutic effect. For evaluation of anti-reflux cardiac function, multiple approaches were valuable, including not only manometric studies but also radiologic studies and 24-hour pH monitoring.