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Lower esophageal sphincter dysfunction in esophageal atresia: nocturnal regurgitation and aspiration pneumonia
Insights
Lower esophageal sphincter incompetence after esophageal atresia repair can cause reflux and pneumonia. Bethanechol may help manage LES incompetence in children until surgery is needed.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pulmonology
Background:
- Esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair can lead to complications.
- Lower esophageal sphincter (LES) incompetence and gastroesophageal reflux (GER) are known post-repair issues.
- Recurrent pneumonia is a significant concern in these patients.
Purpose of the Study:
- To demonstrate the association between LES incompetence, GER, and recurrent pneumonia after EA repair.
- To evaluate the efficacy of esophageal manometry in assessing LES function in young children post-EA repair.
- To investigate LES responsiveness to bethanechol in infants and children with EA.
Main Methods:
- Esophageal manometry was used to evaluate LES function.
- Patients with a history of EA and TEF repair were studied.
- Bethanechol administration was assessed for its effect on LES competence.
Main Results:
- A clear association was found between LES incompetence, GER, and recurrent pneumonia in patients post-EA repair.
- Esophageal manometry proved effective in evaluating LES competence in young children.
- Infants and children with EA-associated LES incompetence showed responsiveness to bethanechol.
Conclusions:
- LES incompetence is linked to GER and recurrent pneumonia following successful EA repair.
- Esophageal manometry is a valuable tool for assessing LES function in this pediatric population.
- Bethanechol may serve as a management option for LES incompetence in children with EA, bridging the gap to surgical intervention.
Abstract:
The association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux, and recurrent pneumonia in patients who have undergone successful repair of esophageal atresia (EA) and tracheoesophageal fistula is demonstrated in this study. The efficacy of esophageal manometric examination in the evaluation of the LES in young children after EA repair is documented. This study also provides evidence that infants and children with LES incompetence associated with EA may have LES responsiveness to bethanechol. Once established by manometry, this responsiveness may be used to manage the patient until surgical repair would be advantageous.