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Motor disorders of the oesophagus in gastro-oesophageal reflux
M J Mahony1, M Migliavacca, L Spitz
1Department of Child Health, Hospital for Sick Children, London.
Insights
Gastro-oesophageal reflux mechanisms in children vary by symptom severity. Serious symptoms link to slower acid clearance and asynchronous reflux, potentially indicating neuropathic processes in reflux oesophagitis.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Esophageal Physiology
Background:
- Gastro-oesophageal reflux (GER) is common in children, but its underlying mechanisms and relationship to oesophagitis are not fully understood.
- Understanding the dynamics of reflux episodes and oesophageal function is crucial for diagnosing and managing pediatric GERD.
- Previous studies have explored factors influencing GER, but detailed analysis of reflux patterns and oesophageal motility in relation to symptom severity is needed.
Purpose of the Study:
- To investigate the mechanisms of gastro-oesophageal reflux in children.
- To differentiate reflux patterns and oesophageal motility in controls, GER alone, and reflux oesophagitis groups.
- To correlate reflux characteristics with symptom severity and identify potential neuropathic indicators in reflux oesophagitis.
Main Methods:
- Oesophageal manometry and pH monitoring were performed in 33 children.
- Participants were categorized into three groups: nine controls, 15 with GER alone, and nine with reflux oesophagitis.
- A total of 122 reflux episodes were analyzed for synchronicity with swallowing, acid clearance time, lower oesophageal sphincter pressure, and oesophageal contraction patterns.
Main Results:
- Reflux episodes were classified as synchronous (67%) or asynchronous (33%) with swallowing.
- Infants with mild symptoms exhibited synchronous reflux, while those with severe symptoms showed slower acid clearance and asynchronous reflux.
- Significant differences in lower oesophageal sphincter pressure and contraction amplitude were observed between controls and patients with GER and reflux oesophagitis.
Conclusions:
- Symptom severity in pediatric GER correlates with reflux patterns and oesophageal clearance.
- Asynchronous reflux and impaired acid clearance are associated with more severe GER symptoms.
- Reflux oesophagitis is characterized by reduced lower oesophageal sphincter pressure and abnormal oesophageal contractions, suggesting a possible neuropathic component.
Abstract:
Mechanisms of gastro-oesophageal reflux were studied by oesophageal manometry and pH monitoring in 33 children: nine controls, 15 with gastro-oesophageal reflux alone, and nine with reflux oesophagitis. A total of 122 episodes of reflux were analysed in detail: 82 (67%) were synchronous with swallowing and 40 (33%) asynchronous. Infants with trivial symptoms had gastro-oesophageal reflux synchronous with swallowing, whereas those with serious symptoms had slower acid clearance and asynchronous reflux. There were significant differences in lower oesophageal sphincter pressure and amplitude of oesophageal contractions between controls and patients with both gastro-oesophageal reflux and reflux oesophagitis. In reflux oesophagitis there was a decrease in lower oesophageal sphincter pressure and the contractions had a bizarre waveform suggesting a neuropathic process.