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[Gastroesophageal reflux and esophageal motility disorders in infants with vagal hyperreflectivity presenting severe
L Michaud1, M D Lamblin, C Carpentier
1Service de pédiatrie, gastroentérologie pédiatrique et génétique médicale, CHU, hôpital Claude-Huriez, Lille, France.
Insights
Gastroesophageal reflux and esophageal dysmotility are common in infants experiencing apparently life-threatening events (ALTE) with vagal hyperreflectivity. These findings suggest potential autonomous nervous system dysmaturity contributing to ALTE in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Autonomic Nervous System
Aim:
The aim of the study was to evaluate the prevalence of gastroesophageal reflux and abnormalities of esophageal motility in a population of neonates referred for apparently life threatening event (ALTE) and presenting vagal hyperreflectivity.
Population And Methods:
The study included 17 infants, who were examined after an ALTE. They were admitted at a mean age of 11.7 weeks (range 1-40 weeks). Vagal hyperreflectivity was confirmed in each infant by oculocardiac reflex. Before treatment, 24-hour intraesophageal pH-monitoring and esophageal manometry were performed.
Results:
pH-monitoring and esophageal manometry were both normal in only two patients. pH-monitoring showed pathological reflux (% of time with pH < 4 more than 4.8%) in 10/17 (59%) patients. Manometric studies showed esophageal dysmotility in 12/17 (71%) of patients. Hypertensive lower sphincter was noted in 11/17 (65%) infants. Patients with normal manometry were older than patients presenting with esophageal dysmotility (P < 0.05).
Conclusion:
This study shows a high frequency of gastroesophageal reflux and dysmotility in infants with vagal hyperreflectivity. Hypertensive lower esophageal sphincter as well as vagal hyperreflectivity may correspond to dysmaturity of autonomous nervous system and facilitate the occurrence of ALTE.