Disorders of the esophageal motor activity in atresia of the esophagus

Romeo, G; Zuccarello, Biagio; Proietto, F.; Romeo, Carmelo

doi:10.1016/s0022-3468(87)80425-6

Cited by 86 publications

(46 citation statements)

References 16 publications

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“…Results obtained with this technique are consistent with findings noted with other investigations such as esophageal manometry and videofluoroscopy [8][9][10]13,14,21,[26][27] in showing impaired motility suggesting that pH-MII is useful and reliable for the long-term evaluation of EA patients. It is known that EA patients may be insensitive to symptoms, and we have also found an impaired motility pattern and severe acid GER in some presumed asymptomatic patients.…”

Section: Discussionsupporting

confidence: 88%

“…Different mechanisms, both congenital and acquired, have been proposed to explain motility disorders. Because these findings are observed in newborns with EA before surgical intervention, a congenital origin has been suggested [13,14]. This hypothesis has been confirmed by morphologic studies that describe abnormalities in Auerbach plexus both in the esophagus and stomach of EA patients [15][16][17][18].…”

Section: Discussionmentioning

confidence: 86%

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Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

Pace

Caruso

Catalano

et al. 2011

Journal of Pediatric Surgery

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 86%

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

Pace

Caruso

Catalano

et al. 2011

Journal of Pediatric Surgery

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“…The clinical features of GER in this particular group of patients suggested that peristalsis, the second anti-reflux barrier, must be also severely damaged. This has been demonstrated repeatedly by radiologic, isotopic, pH-metric and manometric studies in survivors to neonatal operations [4,16,17,21] and even in neonates before the operation [22,23]. This evidence prompted investigation of the esophageal innervation, which is crucial for the regulation of motility.…”

Section: Discussionmentioning

confidence: 82%

Intrinsic esophageal innervation in esophageal atresia without fistula

et al. 2007

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Esophageal atresia and tracheo-esophageal fistula (EA + TEF) are often associated with malformations of neural crest origin. Esophageal innervation is also derived from the neural crest and it is abnormal in EA + TEF in which there is motor dysfunction. Our aim was to examine the intrinsic esophageal innervation in children with isolated EA in which different embryogenic mechanisms might be involved. Specimens from the proximal and distal esophageal segments of 6/35 patients who had esophageal replacement for isolated EA between 1965 and 2006 were suitable for the study. They were sectioned and immunostained with anti-neurofilament (NF) and anti-S-100 antibodies. The muscle and neural surfaces on each section were measured with the assistance of image processing software. The surface of the ganglia and the number of neurons per ganglion were determined at high power microscopy. The findings were compared with those of six autopsy specimens from newborns dead of other diseases by means of standard statistical tests and a significance threshold of P < 0.05. Unmatched age/size of babies in isolated EA and control groups precluded comparison of the relative surfaces occupied by neural elements. Patients with pure EA had denser fibrilar network and larger ganglia than controls. The number of neurons/ganglion were similar in both groups although the cells from EA patients were larger. The findings were similar at both esophageal levels studied. In spite of methodologic biases, it seems that intrinsic esophageal fibrilar network is denser and the intramural ganglia larger with larger cells in patients with pure EA than in controls on both esophageal ends of the organ. These neural anomalies are only in part reminiscent of those described in regular EA/TEF but may as well explain esophageal dysfunction in patients with repaired isolated EA.

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“…It is interesting to note, however, that five of these six patients had an underlying diagnosis of OA. Romeo et al [18] have shown that in OA, oesophageal motility is disordered in both proximal and distal segments prior to repair. Although the upper oesophageal sphincter response to swallowing is mostly normal, an incomplete relaxation may be seen in a proportion of swallows in some patients.…”

Section: Discussionmentioning

confidence: 99%

Oesophageal substitution with free and pedicled jejunum: short- and long-term outcomes

et al. 2006

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In children, the indications for oesophageal substitution are principally, long gap oesophageal atresia (OA), severe anastomotic disruption following primary repair of OA and severe caustic or peptic strictures. We present an outcome review of eight cases who underwent oesophageal substitution with jejunum at our institution between 1986 and 2001. The purpose of this study was to evaluate our experience with free/pedicled jejunal grafts and its long-term outcome as an oesophageal substitute. Operative and postoperative outcome with free and pedicled jejunal grafts in four cases of pure OA, two cases of OA and distal tracheo-oesophageal fistula (TOF), one patient with a high retrolaryngeal oesophageal web and one case of severe caustic oesophageal stricture. Six patients had an oesophagostomy and a gastrostomy fashioned previously. Eleven free jejunal grafts were performed in six patients (three intraoperative redo interpositions for immediate graft loss, three separate grafts in one patient and two free grafts in two patients). One patient's pedicled jejunal graft proximally required microvascular anastomosis while the other had a pedicled graft without microvascular anastomosis. Early postoperative complications included four upper anastomotic leaks (three free grafts, one pedicled with microvascular support), pneumothorax requiring prolonged ventilation and Horner's syndrome. Recurrent laryngeal nerve injury occurred in the patient who had a high retrolaryngeal oesophageal web. During follow up (5-18 years) late complications of upper anastomotic stricture in four patients and graft redundancy with subsequent kinking of the lower anastomosis were observed in one patient. Three patients established a complete oral diet; a further three patients relied on supplemental gastrostomy feeds and one patient is entirely gastrostomy fed. There were two late deaths, one from aspiration and the other from a severe asthmatic attack (5 and 7 months postoperatively, respectively). Our results indicate that there are significant complications related to the use of free jejunal grafts. Early recognition and treatment are of paramount importance in the ultimate achievement of a successful technical outcome.

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Disorders of the esophageal motor activity in atresia of the esophagus

Cited by 86 publications

References 16 publications

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

Intrinsic esophageal innervation in esophageal atresia without fistula

Oesophageal substitution with free and pedicled jejunum: short- and long-term outcomes

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