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Motor efficiency of the refluxing esophagus in basal conditions and after acid challenge
1Universidad del Pais Vasco, Hospital Nuestra Señora de Aranzazu, San Sebastián, Spain.
Insights
Children with gastroesophageal reflux (GER) show impaired esophageal motor efficiency and lower esophageal sphincter pressure. These findings suggest damage to the antireflux barrier and esophageal pump in GER patients.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Gastroesophageal reflux (GER) is common in children.
- Evaluating esophageal function in GER requires comprehensive assessment.
Purpose of the Study:
- To assess esophageal motor efficiency (EME) in children with GER.
- To investigate the relationship between GER, esophageal function, and esophagitis.
- To explore the prognostic value of esophageal motor response to acid instillation.
Main Methods:
- Manometry and endoscopy were used in 60 children with GER and 14 controls.
- Esophageal motor efficiency (EME) was calculated as wave frequency multiplied by mean pressure.
- Tests were performed under basal conditions (EMEB) and after acid (0.1 N HCl) instillation (EMECIH).
Main Results:
- Children with GER had lower LESP, increased nonpropulsive waves, and significantly lower EMEB compared to controls.
- A weak correlation was found between EMEB and esophagitis grade.
- EMECIH was significantly higher in children who responded to medical treatment.
Conclusions:
- GER can damage both the antireflux barrier and the esophageal pump.
- Esophageal motor function is impaired in children with GER.
- Esophageal motor response to acid may predict treatment outcomes.
Abstract:
We have investigated manometrically and endoscopically 60 children with extended pH metering-documented gastroesophageal reflux (GER) and a control group of 14 children of comparable ages. In an attempt to simplify the evaluation of esophageal peristalsis, we measured the frequency of propulsive waves (in waves/hour) and their mean pressure (in mm Hg) in the body of the esophagus and multiplied both values to result in one single figure that reflected esophageal motor efficiency (EME) in some way. We performed the tests in basal conditions (EMEB) and after instillation of 5 mL of 0.1 N CIH into the esophageal lumen (EMECIH). In comparison with controls, refluxing children had a lower sphincter pressure (LESP) (14.9 +/- 8 v 11.8 +/- 6.9 mm Hg, P less than 0.05), an increased proportion of nonpropulsive waves (38.8 +/- 29.3% v 68 +/- 27%, P less than 0.001), and a significantly lower EMEB (896.6 +/- 777 v 375 +/- 306, P less than 0.001). These results suggest that both the sphincteric antireflux barrier and esophageal pump can be damaged in GER. There was a weak, but significant, correlation between EMEB and esophagitis grade (rs = -.25, P less than 0.05). Furthermore, esophageal motor response after CIH instillation may have some prognostic value because EMECIH was significantly higher in those of the 52 children followed-up for more than a year who responded to medical treatment (n = 16) than in those in whom medical treatment was a failure (n = 36) (981.2 +/- 617.4 v 460.5 +/- 452.3, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)