Esophageal body and upper esophageal sphincter motor responses to esophageal provocation during maturation in preterm newborns.
OBJECTIVE
We studied the maturation of esophageal body and upper esophageal sphincter (UES) motor responses that protect against reflux in newborns.


METHODS
The responses of esophageal body and UES on midesophageal provocation were quantified using a micromanometric water perfusion system and a specially designed catheter with a UES sleeve and 5 side-hole recording sites. Eighteen healthy premature infants were studied twice, at 33.4 weeks' and 35.7 weeks' mean postmenstrual ages (PMAs).


RESULTS
Mean threshold volumes and the distribution of responses including secondary peristalsis, UES pressure increase, and primary peristalsis were similar for air and liquids. Secondary peristalsis and UES pressure increases were volume dependent for both studies, but their characteristics changed as PMA increased in that (1) completely propagated secondary peristalsis with liquids increased; (2) proximal esophageal contraction duration was shorter for air and liquids; and (3) propagating velocity for liquids was faster.


CONCLUSIONS
Esophageal and UES motor responses to abrupt midesophageal provocation are present as early as 33 weeks' PMA, and the response-characteristics improve during development. Reflexes that may facilitate esophageal clearance include (1) secondary peristalsis; (2) esophago-UES-contractile reflex; and (3) esophago-deglutition response.
Jadcherla
Sudarshan Rao
SR
Section of Neonatology, Columbus Children's Hospital and Children's Research Institute, Department of Pediatrics, The Ohio State University College of Medicine and Public Health, 43205, USA. jadcherlas@pediatrics.ohio-state.edu
Duong
Hao Q
HQ
Hoffmann
Raymond G
RG
Shaker
Reza
R
D003680:Deglutition Disorders / Q000209:etiology; D004056:Differential Threshold / Q000502:physiology; D004576:Electromyography / Q000295:instrumentation; D015154:Esophageal Motility Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008365:Manometry / Q000295:instrumentation; D009130:Muscle, Smooth / Q000503:physiopathology; D012720:Severity of Illness Index