Disorders of oesophageal motility in children with psychomotor retardation and gastro-oesophageal reflux

Abstract

A group of 25 children affected by different degrees of psychomotor retardation (severe (n = 13); mild-moderate (n = 12)) and symptoms suggesting gastro-oesophageal reflux (GOR) underwent oesophageal manometry and oesophageal pH monitoring. Of these patients, 21 (84%) were affected by GOR. In all children with severe brain damage and GOR (12/13), oesophageal manometry showed marked motility abnormalities that persisted after cure of GOR. In patients with minor retardation and GOR (9/12), oesophageal manometry showed normal motility or a less severe degree of oesophageal motor dysfunction which improved after curing the GOR. These results suggest that oesophageal motor dysfunction is a frequent occurrence in children affected by severe psychomotor retardation and GOR.

Pathophysiological mechanisms of Gastroesophageal reflux disease in children

“…These defects were also more prevalent with increasing severity of disease [12,14,19,20,26]. In contrast, Sondheimer [17] reported few motility defects in infants with GERD but found that these infants swallowed less frequently, particularly during sleep.…”

“…In addition to changes in esophageal pressure wave propagation, severe GERD with reflux esophagitis is associated with a 30% to 50% decrease in pressure wave amplitude, indicating that the contractile strength of the esophagus is also impaired [12,14,15,19,20,26]. However, lower pressure wave amplitude does not necessarily lead to impaired clearance, as low peak amplitude pressure waves have been shown to be as effective as high peak amplitudes in facilitating bolus transit of liquids, provided that a threshold amplitude of greater than 20 mm Hg above intrabolus pressure is reached [38].…”

“…Measurements in children with GERD indicate that average LES pressures range from 4 to 25 mm Hg, with most studies recording LES pressures of greater than 10 mm Hg [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Interestingly, studies that have compared GERD children with "normal" children (ie, those who presented with symptoms but were found to be free of GERD after further investigation) found LES pressure to be 6 to 15 mm Hg lower in children with GERD [7,19]. Those studies that grouped children according to the severity of GERD [8,15] and/or responsiveness to therapy [9,20] reported reduced LES pressure with increased severity of disease.…”

Managing childhood gastro-oesophageal reflux

“…It is more marked in those in whom gastric emptying is slow, or in those whose upper gastrointestinal motility is disordered as part of severe neurodevelopmental impairment (e.g. cerebral palsy) or because of cows' milk intolerance 3–5. Reflux is aggravated by chest physiotherapy and when oesophageal sphincter pressure is reduced by drugs such as theophylline or caffeine 6 , 7.…”

Antroduodenal motor function and gastro-oesophageal reflux in neurologically impaired children, adolescents and young adults

“…Sir: Although gastro-intestinal symptoms are common in neurologically impaired patients, there are limited data concerning possible motor dysfunction responsible for symptoms in these patients [3,4]. We therefore evaluated antroduodenal motility, gastro-oesophageal re¯ux (GOR), and lower oesophageal sphincter (LOS) pressures in 11 neurologically impaired children, adolescents and young adults who presented with vomiting, haematemesis, or abdominal distension.…”