Motor Function of the Esophagus After Caustic Burn

Abstract

During the subacute and chronic phases of esophagitis due to ingestion of a caustic substance, the patient commonly displays stricture, esophageal rigidity and dysphagia. We used esophageal manometry, radiology, pH monitoring and 99mTc scintigraphy to investigate esophageal motor function in 25 children (mean age 24 +/- 7 months) with chronic esophagitis after second- and/or third-degree caustic burns. The results were compared with those for a control group of 12 children (mean age 32 +/- 19 months) under surveillance for suspected gastroesophageal reflux (GER) but for whom this pathology was later ruled out. Seventeen (68%) of the lesioned-group children showed esophageal dysfunction as revealed by monitoring of pH over a 24-hour period. Over this period, the mean percentage of time with pH below 4 was 19 +/- 10%, the mean number of reflux episodes was 48 +/- 52, the mean number of reflux episodes lasting longer than 5 min was 10 +/- 5, and the mean duration of the longest reflux episode was 51 +/- 21 min. Manometry indicated that, in the lesioned group, an average of 77 +/- 18% of peristaltic waves were nonpropulsive, while the mean Esophageal Work Index (number of propulsive waves per hour x mean maximum pressure developed during propulsive waves) was 227 +/- 192 units. All of the above means were significantly different (p < 0.01) from the corresponding control-group means. Esophageal strictures were observed in 60% (15) of the children. In 2 cases it was minimal, 2 cases moderate and 11 cases had severe strictures. 99mTc scintigraphy indicated that esophageal transit was slightly delayed in four, moderately delayed in five and severely delayed in 16 of the lesioned-group subjects. There was close correspondence between the results of manometry and scintigraphy as regards severity of esophageal dysfunction. These results indicate that motility disturbances and GER are very frequent sequelae of caustic burns of the esophagus, and should be taken into account when evaluating symptoms and deciding on the therapeutic strategy (including diet) to be followed.

Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

“…Bautista et al (8) have found a higher prevalence of oesophagitis in patients with CES. In our study, one third (14 of 52) of patients with CES had oesophagitis.…”

A functional study of caustic strictures of the esophagus in children

“…However, esophageal injuries are equally deep and result in strictures in about 30% of all accidents (8)(9)(10). Recent studies have reported motor dysfunction after second-or third-degree burns and complete absence of peristalsis, and low-amplitude waves after swallows were found in 70% of recordings on manometry (5,11). Low-amplitude aperistaltic contractions and narrowing and shortening of the esophagus have been considered to account for impaired esophageal motor function (5,6,(11)(12)(13).…”

“…Recent studies have reported motor dysfunction after second-or third-degree burns and complete absence of peristalsis, and low-amplitude waves after swallows were found in 70% of recordings on manometry (5,11). Low-amplitude aperistaltic contractions and narrowing and shortening of the esophagus have been considered to account for impaired esophageal motor function (5,6,(11)(12)(13). These studies indicated that development of esophageal stricture, impaired motility, and gastroesophageal reflux are very frequent outcomes of caustic esophageal burns and should be considered when evaluating symptoms and defining therapeutic strategies.…”

“…Tissue penetration with lique- B D factive necrosis is followed by destruction of the epithelium and submucosa with intense inflammation, and in severe burns inflammation may extend through the muscle layer. Impaired esophageal motility may be the result of fibrotic structure, shortened esophagus, and reduction in neuron number in the myenteric plexus (5,11). The large number of dilatations is also implicated as a factor leading to tissue injury and dysmotility (11).…”

“…However, it has been observed that swallowing difficulties are not always related to the esophageal stricture and that motility abnormalities also play an important role as a cause of the symptom (5,6).…”