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Published on: August 25, 2015
A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery
T Omari1,2, F Connor3, L McCall4
1College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Insights
Pre-operative high-resolution esophageal impedance manometry (HRIM) can predict post-operative dysphagia after anti-reflux surgery. An elevated pressure-flow index, particularly during viscous bolus clearance, indicates higher risk for swallowing difficulties.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Swallowing Disorders
Background:
- Dysphagia is a potential complication following anti-reflux surgery.
- The predictive value of high-resolution esophageal impedance manometry (HRIM) for post-operative dysphagia remains unclear.
- This study investigates HRIM's role in identifying children at risk for dysphagia after surgery for gastroesophageal reflux (GER) disease.
Purpose of the Study:
- To evaluate the utility of HRIM in predicting post-operative dysphagia in children undergoing Nissen fundoplication.
- To identify specific esophageal function parameters that correlate with dysphagia symptoms after surgery.
Main Methods:
- Prospective study of 13 children (aged 6.8-15.5 years) undergoing Nissen fundoplication.
- Pre- and post-operative dysphagia scores were assessed.
- HRIM was performed using liquid, viscous, and solid boluses to evaluate esophageal motility, EGJ morphology, and pressure-flow variables.
Main Results:
- A positive correlation was found between pre-operative pressure-flow index and post-operative dysphagia score for viscous boluses (r=0.771, p<0.005).
- Ramp pressure during viscous bolus clearance was the primary contributor to this correlation (r=0.819, p<0.005).
Conclusions:
- Pre-operative assessment of dysphagia symptoms and esophageal function is crucial for mitigating post-operative issues.
- An elevated pressure-flow index, especially in patients with normal baseline motility, may predict the development of post-operative dysphagia.
Background:
The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia.
Methods:
Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived.
Results:
Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005).
Conclusions:
In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.
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