Mechanisms responsible for gastroesophageal reflux in children.
BACKGROUND & AIMS: There is limited information about the motor mechanisms responsible for gastroesophageal reflux ( GER) in children. The aim of this study was to evaluate the relationship between esophageal body and lower esophageal sphincter (LES) motor events and the occurrence of GER. METHODS: Concurrent esophageal manometry and pH monitoring was conducted for 4 hours postprandially in 37 children referred for evaluation of suspected pathological GER. Presence of esophagitis and/or abnormal esophageal acid exposure was used to classify patients into two groups: those with pathological GER (group A; n = 24) and those in whom GER was not confirmed (group B; n = 13). RESULTS: GER occurred during LES relaxations unassociated with swallowing within 5 seconds before and 2 seconds after the onset of LES relaxation in 58% (group A) and 69% (group B) of the analyzable episodes. These swallow-independent sphincter relaxations satisfied criteria for classification as transient LES relaxations. An additional 23% (group A) and 19% (group B) of reflux episodes could have been a result of transient LES relaxation associated with swallowing by chance. Persistent absence of LES tone was an infrequent association of reflux and was confined to group A patients (8% of episodes). CONCLUSIONS: Transient LES relaxation is the most important cause of GER in children. Absent basal LES pressure is a relatively infrequent cause of reflux and only in children with pathological GER.[1]References
- Mechanisms responsible for gastroesophageal reflux in children. Kawahara, H., Dent, J., Davidson, G. Gastroenterology (1997) [Pubmed]
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