ISSN:
1437-9813
Keywords:
Esophagus
;
Gastroesophageal reflux
;
Manometry
;
Sedation
;
Peristalsis
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Among the tests currently available for diagnosis of gastroesophageal reflux (GER), esophageal manometry is the hardest to perform in alert children because of their lack of cooperation. Therefore, it is usually performed under some form of sedation. In an attempt to investigate whether medication by itself modifies esophageal motility, we compared the manometric data of 18 children with pH-probe documented GER before and after sedation (meperidine 1.5 mg/kg, chlorpromazine 1 mg/kg, promethazine 1 mg/kg i.m.). Sedation induced the following changes in motor function compared to that in the unsedated state: (1) lower esophageal sphincter pressure decreased from 16.4 ± 7.3 to 11.4 ± 6.9 (P 〈0.001), whereas sphincter length remained unchanged; (2) esophageal peristaltic activity almost disappeared in terms of number of waves per hour (106.4 ± 60.1 vs 3.8 ± 6.2, P 〈0.001) while nonpropulsive activity became predominant, although only in relative terms (percent of tertiary waves 16.5 ± 13.9 vs 75.1 ± 25, P 〈0.001); (3) the mean pressure of the propulsive waves was also significantly decreased (65.2 ± 20.6 vs 37.9 ± 26.5, P 〈0.001), and as a result, esophageal motor efficiency (number of primary waves per hour multiplied by the mean pressure of the waves in mmHg) decreased enormously (from 6681.7 ± 4113.7 to 223.9 ± 372.6, P 〈0.001). Comparison with a group of sedated controls demonstrated that, under equal conditions, both barrier and pump functions were significantly weakened in refluxing patients. The limited diagnostic value of manometry thus remains unquestioned by the present study. Our data suggest that: (1) motor behavior of the esophagus in unsedated children with GER is quite close to that observed in refluxing adults; and (2) sedation of itself substantially modifies the esophageal sphincter barrier and esophageal propulsive “pump”. If sedation is to be used for manometric studies in children, the results so obtained should only be compared to those of controls under the same conditions.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00174339
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