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Esophageal Motility in Children With Suspected Gastroesophageal Reflux Disease

Hoffman, Ilse*; De Greef, Toon; Haesendonck, Nancy; Tack, Jan

Journal of Pediatric Gastroenterology & Nutrition: June 2010 - Volume 50 - Issue 6 - p 601–608
doi: 10.1097/MPG.0b013e3181c1f596
Original Articles: Gastroenterology

Background and Objectives: Motility abnormalities in adults with gastroesophageal reflux disease (GERD) include nontransmitted contractions, reduced distal esophageal contraction amplitude, and simultaneous contractions. Information on esophageal body motility in children with GERD is scarce. Our aim was to study esophageal motility patterns in children with GERD, taking into account the presence of anatomical abnormalities and neurological impairment, the effect of age on esophageal motility in GERD, and the relation between esophageal manometry and GERD severity parameters (acid exposure and presence of esophagitis).

Patients and Methods: Consecutive children referred for severe GER(D) symptoms underwent a barium swallow, upper endoscopy, pH monitoring, and stationary water-perfused esophageal manometry.

Results: Mean lower esophageal sphincter (LES) pressure and velocity of propagation in the proximal and distal esophagus decreased with age in this group of children with GERD (all P < 0.01). Severely disturbed esophageal motility was found in children with previous esophageal atresia. Patients with psychomotor retardation had significantly lower occurrence of peristaltic waves (94% ± 21% vs 79% ± 38%; P = 0.001), distal propagation velocity (0.8 ± 0.4 vs 0.6 ± 0.5 cm/s; P = 0.05), and distal contraction duration (3.1 ± 0.8 vs 3.4 ± 1 seconds; P = 0.05). None of the manometric characteristics differed between patients with normal or abnormal esophageal pH monitoring or with or without erosive esophagitis.

Conclusions: LES pressure and esophageal velocity decreased with increasing age. Esophageal manometry is severely impaired in children with esophageal atresia and psychomotor retardation. No specific esophageal motor abnormalities related to the presence of endoscopic esophagitis or abnormal pH monitoring were found.

*Division of Pediatrics, Belgium

Division of Internal Medicine, Department of Gastroenterology, University Hospitals Leuven-Gasthuisberg, Leuven, Belgium.

Received 7 February, 2008

Accepted 17 September, 2009

Address correspondence and reprint requests to Dr Ilse Hoffman, Herestraat 49, 3000 Leuven, Belgium (e-mail: ilse.hoffman@uz.kuleuven.ac.be).

The authors report no conflicts of interest.

© 2010 Lippincott Williams & Wilkins, Inc.