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Mechanisms responsible for gastroesophageal reflux in children

H Kawahara1, J Dent, G Davidson

  • 1Department of Pediatric Surgery, Osaka Medical Center, Japan.

Gastroenterology
|August 1, 1997
PubMed

Insights

Transient lower esophageal sphincter (LES) relaxations are the primary cause of gastroesophageal reflux (GER) in children. Persistent low LES pressure is a less common factor, mainly seen in pathological GER cases.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Motility Disorders

Background:

  • Limited understanding of motor mechanisms driving gastroesophageal reflux (GER) in pediatric populations.
  • Investigating the link between esophageal body and lower esophageal sphincter (LES) motor events and GER occurrence.

Purpose of the Study:

  • To elucidate the primary motor events contributing to GER in children.
  • To differentiate the roles of transient LES relaxations and absent basal LES pressure in pediatric GER.

Main Methods:

  • Concurrent esophageal manometry and pH monitoring in 37 children over 4 hours postprandially.
  • Classification of patients into pathological GER (Group A) and non-GER (Group B) based on esophagitis and/or acid exposure.

Main Results:

  • Transient LES relaxations, independent of swallowing, were associated with 58% (Group A) and 69% (Group B) of GER episodes.
  • Swallowing-associated LES relaxations accounted for an additional 19-23% of reflux events.
  • Persistent absence of LES tone was observed in only 8% of GER episodes and exclusively in Group A.

Conclusions:

  • Transient LES relaxation is the predominant mechanism underlying GER in children.
  • Absent basal LES pressure is an infrequent cause of GER, primarily observed in children with confirmed pathological GER.
Abstract

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