Lack of distal esophageal contractions is a key determinant of gastroesophageal reflux disease after repair of esophageal atresia.
OBJECTIVE
The objective of this study is to investigate the characteristics of esophageal motor activity responsible for the development of gastroesophageal reflux (GER) in patients with esophageal atresia (EA).


METHODS
The subjects consisted of 29 patients with EA (1 month to 19 years). Computerized esophageal manometry was conducted to investigate esophageal contractions at swallow. A topographic esophageal manometric analysis was conducted in each subject, providing 3-dimensional displays to reveal the pressure continuum representing esophageal contractions.


RESULTS
Significant contractions in the middle esophagus just below the anastomosis were absent in all subjects. Contractions in the distal esophagus were conspicuously absent in 17 subjects. Of these 17, 6 had already undergone fundoplication, and 9 had symptomatic GER requiring fundoplication subsequent to this study. The remaining 12 patients had contractions in the distal esophagus and did not require medical/surgical intervention. A lack of distal esophageal contractions was significantly correlated with the development of GER (P < .001). There was a significant difference in esophageal acid exposure between the 2 groups (median, 38% vs 4%, P < .001).


CONCLUSIONS
Lack of distal esophageal contractions indicating an impaired clearing capacity is considered a potential key determinant of GER in patients with EA.
Kawahara
Hisayoshi
H
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
Kubota
Akio
A
Hasegawa
Toshimichi
T
Okuyama
Hiroomi
H
Ueno
Takehisa
T
Watanabe
Takashi
T
Morishita
Yuji
Y
Saka
Ryuta
R
Fukuzawa
Masahiro
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004933:Esophageal Atresia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D008991:Monitoring, Physiologic; D009119:Muscle Contraction / Q000502:physiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome