DOZ047.122: Inadequate response of atretic esophagus during acidic gastroesophageal reflux

Abstract Patients with atretic esophagus (OA) are candidates to severe gastroesophageal reflux. In a previous study, we observed that in OA operated children the complete transmission of contractions during the whole day and during acid reflux periods is poor compared to controls (C). Investigate the motor response of OA during periods of meal (M) and periods of acid reflux (GOR) in OA patients. Methods Prolonged monitoring of esophageal motor function recorded with three sensors: P1 above and P2, P3 below the suture, combined with pH-metry between P2 and P3. Number/min and amplitude of contractions and transmissions between P1-2-3 or P2-3 are compared during total time, meal and reflux periods and between OA with or without GOR. Population 13 operated patients (OA) mean age 7.75 years and 10 controls (C). Results Contractions/min in OA at P1 M = 1.4 SD 1.2 versus GOR = 0.8 SD 1.1: P < 0.05 at P2 M = 2.0 SD 1.4 versus GOR = 1.4 SD1.4: P < 0.05 at P3 M = 2.2 SD 1.3 versus GOR = 1.5 SD1.4: P < 0.05 Complete transmission (P1-2-3) in OA during M compared with total time (T) is increased (29 vs. 32%: P < 0.5), but not during GOR (29 vs. 28%: NS). No difference in distal transmission (P2-3) between C and OA during M (68.8 vs. 63.2) but difference during GOR (69.8 vs. 43 P < 0.01). Contractions/min are not different during M between 7/13 patients with normal (OAN) and 6/13 with abnormal (OAR) reflux index but differ during GOR: P2 OAN = 2.1 vs. P2 OAR = 0.6, P < 0.01; P3 OAN = 2.2 vs. OAR = 0.6, P < 0.05. Complete transmission (P1-2-3) in OAN is not different during M or GOR but different in OAR (M: 74.2 SD 33.5 vs. GOR 54.7 SD 30.5: P < 0.005); distal transmission (P2-3) is not different between OAN and OAR during M and RGO periods. Conclusion Esophageal motility remains impaired in the operated OA. GOR stimulations produce weaker responses than meals. In OAR alterations of response to GOR are more important in terms of decreased number of distal contractions and total transmission suggesting a motility disorder but also an altered sensitivity reducing primary peristaltic response to reflux.