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Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy
Insights
Severe gastroesophageal reflux in infants is linked to upper gastrointestinal motility disorders. This study found impaired esophageal peristalsis and delayed gastric emptying in infants with severe reflux, suggesting a widespread motility issue.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Infant Health
Background:
- Gastroesophageal reflux (GER) is common in infants.
- Severe GER can lead to failure to thrive and recurrent pulmonary disease.
- The underlying mechanisms of severe infant GER are not fully understood.
Purpose of the Study:
- To investigate upper gastrointestinal motility in infants with severe gastroesophageal reflux.
- To compare motility parameters between infants with severe GER and those with milder symptoms.
- To identify correlations between reflux severity and motility abnormalities.
Main Methods:
- Esophageal manometry, pH probe studies, and gastric emptying studies were performed on 34 infants.
- Infants were categorized into groups based on GER severity and associated complications.
- Statistical analyses were used to compare motility parameters and reflux severity.
Main Results:
- Infants with severe GER (failure to thrive or recurrent pulmonary disease) exhibited significantly prolonged postprandial reflux time compared to controls (p < 0.01).
- Decreased distal esophageal peristaltic amplitude and increased nonperistaltic sequences were observed in infants with severe GER (p < 0.01).
- Gastric emptying was significantly delayed in infants with severe GER, correlating with impaired esophageal peristalsis and increased reflux (r = 0.68 and r = 0.60, respectively).
Conclusions:
- Severe gastroesophageal reflux in infancy is associated with a diffuse upper gastrointestinal motility disorder.
- Impaired esophageal and gastric motility contribute to the pathophysiology of severe infant GER.
- These findings highlight the complex interplay between reflux and motility in affected infants.
Abstract:
Thirty-four infants with symptoms of gastroesophageal reflux were evaluated by esophageal manometry, pH probe, and gastric emptying studies. Infants with failure to thrive (group A) and recurrent pulmonary disease (group B) had more severe reflux by pH probe (41.6% and 36.3% reflux time postprandially, respectively) than the group of infants without serious sequellae of gastroesophageal reflux (group C), who had 19.0% reflux time postprandially, p less than 0.01. Lower esophageal sphincter pressure did not vary significantly between infants with severe reflux and milder disease. Groups A and B had significantly decreased peristaltic amplitude in the distal body of the esophagus (28.3 +/- 4.8 and 23.2 +/- 5.5 mmHg, respectively) when compared to group C (50.2 +/- 3.2 mm Hg, p less than 0.01); in addition to a significantly increased number of nonperistaltic sequences. Gastric emptying of isotope-labeled cow's milk formula after 1 h was 20.9% and 22.8% in groups A and B, respectively; significantly delayed compared to 40.6% of the meal emptied in group C infants. Gastric retention was significantly correlated with impaired distal esophageal peristaltic amplitude (r = 0.68) and increased postprandial pH documented reflux (r = 0.60). Our results provide evidence for the diffuse nature of the upper gastrointestinal motility disorder present in severe gastroesophageal reflux of infancy.