Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment

Abstract

Esophageal dysmotility is almost universal after esophageal atresia (EA) repair and is mainly related to the developmental anomaly of the esophagus. Esophageal dysmotility is involved in the pathophysiology of numerous symptoms and comorbidities associated with EA such as gastroesophageal reflux disease, aspiration and respiratory complications, and symptoms of dysphagia and feeding disorders. High-resolution esophageal manometry (HREM) has facilitated the characterization of the dysmotility, but there is an incomplete correlation between symptoms and manometrical patterns. Impedance coupled to HREM should help to predict the clinical outcome and therefore personalize patient management. Nowadays, the management of esophageal dysmotility in patients with EA is essentially based on treatment of associated inflammation related to peptic or eosinophilic esophagitis.

Gastro-Esophageal Reflux in Children

“…This tendency seems to increase with time [ 36 , 37 ]. Patients with EA are more likely to develop severe GERD due to multiple reasons: impaired anatomy with hiatus hernia or abnormal position of the intrathoracic part of esophagus, as well as due to complications arising from the vagal nerve injury (gastroparesis or delayed gastric emptying and esophageal motor activity dysfunction affecting esophageal acid clearance) [ 38 ].…”

The morphopathological particuliarities of intrinsic innervation of the esophagus in newborns with esophageal atresia and inferior tracheoesophageal fistula

“…Neurons were more frequent with normal cytology. In 52.9% [9] cases were determined ganglio-neuronal abnormalities structures as: intumescent cell, nuclei of various sizes achromatic reflecting the reduced functionality features (fig. 2C).…”

“…Esophageal dysmotility in children with esophageal atresia causes development of gastroesophageal reflux, dysphagia, eating disorders, aspiration, these symptoms persisting into adulthood, negatively affecting the quality of life. Chronic exposure of the esophageal mucosa to the action of the acidic environment can lead to Barrett's esophagus and esophageal carcinoma [9,10,18,26,28].…”

Behandlung der Ösophagusatresie mit unterer tracheoösophagealer Fistel – Zusammenfassung der aktuellen S2K-Leitlinie der DGKCH

“…Diese ist auf eine Dysmotilität der Speiseröhre, eine Abflachung des HIS'schen Winkels durch Zug am Ösophagus sowie durch eine ‚Inkompetenz' des Sphinkters (sogenannte "transient lower esophageal sphincter relaxation") zurückzuführen [83]. Ob die ösophageale Dysmotilität angeboren und / oder durch die Mobilisation der unteren Speiseröhre während der primären Anastomose erworben ist, ist nicht geklärt [20]. Zum Nachweis einer GÖRK stehen die Röntgenkontrastdarstellung, die 24h pH-Metrie bzw.…”