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The lower esophageal sphincter in gastroesophageal reflux in children
Insights
Gastroesophageal reflux in infants is linked to shorter lower esophageal sphincter length. Acidic esophageal pH detection is a sensitive measure for reflux, with lower sphincter pressures in symptomatic patients.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Physiology
Background:
- Gastroesophageal reflux (GER) is common in infants.
- Radiologic evidence of GER is present in many children.
- Understanding esophageal function is crucial for managing infant reflux.
Purpose of the Study:
- To evaluate esophageal function in infants with radiologic evidence of GER.
- To identify factors associated with GER severity and treatment response.
Main Methods:
- Studied 51 children under 2 years old with confirmed GER.
- Utilized acid esophageal pH monitoring to detect reflux.
- Measured lower esophageal sphincter (LES) pressures and intra-abdominal LES length.
Main Results:
- Acidic esophageal pH was a sensitive indicator of GER.
- LES pressures were significantly higher in infants with respiratory symptoms (18.0 mmHg) compared to those without (9.5 mmHg).
- Intra-abdominal LES length was shorter in GER patients (0.51 cm) than controls (0.75 cm) and shortest in surgically treated infants (0.34 cm).
Conclusions:
- Shorter intra-abdominal LES length is associated with GER in infants.
- LES pressure differences may correlate with symptom severity.
- LES length is a potential factor differentiating medical vs. surgical treatment needs.
Abstract:
Esophageal function was evaluated in 51 children less than 2 years of age with radiologic evidence of gastroesophageal reflux. Detection of an acid esophageal pH was a sensitive measure of gastroesophageal reflux. Lower esophageal sphincter pressures were greater in reflux patients with respiratory symptoms (18.0 +/- 1.4 mm Hg) than in reflux patients without respiratory symptoms (9.5 +/- 1.0 mm Hg). The intra-abdominal segment of the lower esophageal sphincter was shorter in patients with reflux than in controls (0.51 +/- 0.05 cm vs. 0.75 +/- 0.08 cm). It was also shorter in patients requiring surgical therapy (0.34 +/- 0.05 cm) than in those responding to medical therapy (0.63 +/- 0.07 cm).