H Kawahara1, K Nakajima, M Yagi, H Okuyama, A Kubota, A Okada. 1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan. kawahara@pedsurg.med.osaka-u.ac.jp
Abstract
BACKGROUND: In this study, we attempted to define the lower esophageal sphincter (LES) motor events associated with the occurrence of gastroesophageal reflux (GER) in neurologically impaired children in whom of GER disease recurred after laparoscopic Nissen fundoplication (LNF). METHODS: Of 45 neurologically impaired children who had previously undergone LNF, six children in whom recurrence of GER disease was documented by 24-h esophageal pH monitoring were studied. Concurrent esophageal manometry and pH monitoring were conducted for 1 h both before and after the administration of apple juice (10 ml/kg). RESULTS: A total of 89 reflux episodes were recorded in the course of the study. Of these, 51 episodes (57%) were associated with transient LES relaxation. In the remainder, reflux occurred across a contracted LES in 21 episodes (24%) and during absent basal LES tone in 15 episodes (17%). In four of six patients, transient LES relaxation was responsible for more than half of the reflux episodes. CONCLUSION: Transient LES relaxation is the predominant mechanism of reflux in neurologically impaired children with recurrent GER after LNF.
BACKGROUND: In this study, we attempted to define the lower esophageal sphincter (LES) motor events associated with the occurrence of gastroesophageal reflux (GER) in neurologically impaired children in whom of GER disease recurred after laparoscopic Nissen fundoplication (LNF). METHODS: Of 45 neurologically impaired children who had previously undergone LNF, six children in whom recurrence of GER disease was documented by 24-h esophageal pH monitoring were studied. Concurrent esophageal manometry and pH monitoring were conducted for 1 h both before and after the administration of apple juice (10 ml/kg). RESULTS: A total of 89 reflux episodes were recorded in the course of the study. Of these, 51 episodes (57%) were associated with transient LES relaxation. In the remainder, reflux occurred across a contracted LES in 21 episodes (24%) and during absent basal LES tone in 15 episodes (17%). In four of six patients, transient LES relaxation was responsible for more than half of the reflux episodes. CONCLUSION: Transient LES relaxation is the predominant mechanism of reflux in neurologically impaired children with recurrent GER after LNF.
Authors: Jan Mathei; Willy Coosemans; Philippe Nafteux; George Decker; Paul De Leyn; Dirk Van Raemdonck; Ilse Hoffman; Christiane Deboeck; Marijke Proesmans; Toni Lerut Journal: Surg Endosc Date: 2007-10-18 Impact factor: 4.584