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Strain induced augmentation of upper oesophageal sphincter pressure in children

J Willing1, Y Furukawa, G P Davidson

  • 1Gastroenterology Unit, Adelaide Children's Hospital, South Australia.

Gut
|February 1, 1994
PubMed

Insights

Gastroesophageal reflux in children is not caused by a defective upper esophageal sphincter response to straining. Instead, a failure to augment upper esophageal sphincter tone during strain may be a secondary factor in developing reflux.

Area of Science:

  • Pediatric Gastroenterology
  • Physiology
  • Reflux Disorders

Background:

  • Gastroesophageal reflux (GER) is a common concern in infants and children.
  • Oesophagopharyngeal reflux (OPR) is a specific type of reflux involving the pharynx and esophagus.
  • The role of the upper oesophageal sphincter (UES) in OPR during straining is not fully understood.

Purpose of the Study:

  • To investigate the hypothesis that troublesome oesophagopharyngeal reflux arises from defective upper oesophageal sphincter response to straining in children.
  • To analyze the pressure dynamics of the pharynx, UES, oesophageal body, and gastric pressures during spontaneous straining events in children with suspected GER.

Main Methods:

  • Study included 53 children (2-81 months) referred for suspected GER.
  • Analysis of spontaneously occurring pharyngeal, UES, oesophageal body, and gastric pressures after feeding.
  • Identification and analysis of inspiratory strain and sustained strain episodes.

Main Results:

  • During inspiratory strain, UES pressure significantly increased (5 to 27 mm Hg, p < 0.01).
  • Sustained strains also augmented UES pressure (39 to 60 mm Hg, p < 0.01).
  • No significant difference in UES response patterns to straining was observed between children with and without OPR.

Conclusions:

  • The study suggests that a defective UES response to straining is unlikely to be the primary cause of OPR in children.
  • Failure of UES tone augmentation during strain-induced increases in oesophageal pressure may be a secondary factor in OPR development.
  • Further research is needed to elucidate the precise mechanisms of OPR in pediatric populations.

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