Esophageal motor dysfunction persists in children after surgical cure of reflux: an ambulatory manometric study

Abstract

Background/purpose: Esophageal dysmotility shown by perfusion manometry in children with gastroesophageal reflux can be primary or acquired. This study examines by combined ambulatory pH-metry and manometry the nature of motor dysfunction and whether it improves after surgical cure of reflux.

Methods: Sixteen refluxing children aged 131 +/- 54 months were studied by combined ambulatory pH-metry and manometry before and more than 6 months after successful fundoplication. pH-metric and manometric variables were compared at both time end-points by paired statistical tests accepting a significance level of P less than.05.

Results: Operation cured all patients clinically and pH-metrically, but, in spite of this, only the frequency of motor sequences decreased significantly after the operation from 1 (0.45) to 0.8 (0.6) waves per minute (median [interquartile range]). Wave amplitude and duration were similar in both conditions; the proportion of peristaltic waves was normal and did not change before and after the operation (79.5% [17.25] v 81.4% [21.5]; not significant), whereas the proportions of complete (63.2% [17.5] v 67.8% [19.3]; not significant) and effective (32.4% [31.95] v 27.25% [22.5]; not significant) waves were definitely low and remained so after treatment.

Conclusions: The esophagus of children with GER has mild disturbances of peristaltic activity with waves often incomplete, weak, and scarcely effective. Dismotility does not improve after successful fundoplication suggesting that it could be a primary phenomenon.