title: Esophageal dysmotility in children breast-fed by mothers with silicone breast implants. Long-term follow-up and response to treatment.
abstract: Our aims were to determine the long-term clinical and manometric follow-up of 11 children with previously documented esophageal dysmotility, who had been breast-fed by mothers with silicone breast implants, their response to prokinetic agents, and to analyze changes in macrophage activation. Seven of 11 children had subjective clinical improvement. Weight/ height ratios remained the same or improved in 9/11. Biopsies at follow-up endoscopy were either normal or demonstrated mild esophagitis in 8/10. LES and UES pressures and percent propagation were not significantly different at follow-up, while wave amplitude significantly increased. Following intravenous metoclopramide, LES pressure, percent propagation, and wave amplitude significantly increased while UES pressure was unchanged. Urinary neopterin significantly decreased at follow-up, while urinary nitrates were unchanged. Esophageal dysmotility is chronic in this group of children, suggesting persistent autonomic nervous system dysfunction. Prokinetic agents may be useful in long-term management. The decreasing urinary neopterin levels suggest that, ultimately, there may be improvement in esophageal motility.
authors.affiliation: Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Levine
authors.forename: H
authors.initials: H
authors.lastname: Trachtman
authors.forename: D M
authors.initials: DM
authors.lastname: Gold
authors.forename: M J
authors.initials: MJ
authors.lastname: Pettei
mesh_terms: D001708:Biopterins / Q000031:analogs & derivatives / Q000652:urine; D001942:Breast Feeding; D018427:Breast Implants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015154:Esophageal Motility Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008787:Metoclopramide / Q000494:pharmacology; D019798:Neopterin; D009566:Nitrates / Q000652:urine; D011312:Pressure; D012828:Silicones / Q000009:adverse effects*
chemical_list: D009566:Nitrates; D012828:Silicones; D001708:Biopterins; D019798:Neopterin; D008787:Metoclopramide