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Lower esophageal sphincter function in children with and without gastroesophageal reflux

S P Moroz, J Espinoza, W A Cumming

    Gastroenterology
    |August 1, 1976
    PubMed

    Insights

    Lower esophageal sphincter (LES) pressure is generally well-developed in infants and children. While low LES pressure is not the only cause of gastroesophageal reflux (GER), pharmacological stimulation may aid GER management.

    Area of Science:

    • Pediatric Gastroenterology
    • Physiology

    Background:

    • Gastroesophageal reflux (GER) is common in infants and children.
    • The role of lower esophageal sphincter (LES) pressure in GER pathophysiology requires further elucidation.

    Purpose of the Study:

    • To assess resting lower esophageal sphincter (LES) pressure in infants and children.
    • To investigate the relationship between LES pressure and gastroesophageal reflux (GER).
    • To evaluate the effect of bethanechol on LES pressure in pediatric patients.

    Main Methods:

    • Measured resting LES pressure and sphincter length in 62 control subjects and 35 GER patients (2 weeks to 12 years).
    • Administered subcutaneous bethanechol (0.1 mg/kg) to assess LES pressure response.
    • Radiologically determined reproducible GER in patient group.

    Main Results:

    • LES pressure was well-developed by 2 weeks of age and higher in infants under 1 year compared to older children.
    • LES length increased with age in controls; shorter in GER patients over 6 months.
    • Only 16/35 GER patients had LES pressure below normal; GER often occurred without hiatus hernia.
    • Clinical improvement in GER patients correlated with normalized LES pressure, even with hiatus hernia.
    • Bethanechol stimulated LES pressure similarly in controls and GER patients.

    Conclusions:

    • Low LES pressure is not the sole cause of GER in infants and children.
    • GER can occur despite normal LES pressure and in the absence of hiatus hernia.
    • Pharmacological stimulation of LES pressure may be a valuable addition to GER medical management.

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