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. 1997 Mar;40(3):370–375. doi: 10.1136/gut.40.3.370

Characterisation of relaxation of the lower oesophageal sphincter in healthy premature infants.

T I Omari 1, K Miki 1, G Davidson 1, R Fraser 1, R Haslam 1, W Goldsworthy 1, M Bakewell 1, J Dent 1
PMCID: PMC1027088  PMID: 9135527

Abstract

BACKGROUND: Gastro-oesophageal reflux disease causes significant morbidity in premature infants, but the role of dysfunction of the lower oesophageal sphincter (LOS) in this condition is unclear. METHODS: Oesophageal manometry was performed after gavage feeding in 13 healthy preterm neonates (postmenstrual age > or = 33 weeks) with a perfused sleeve with side hole assembly. Swallow related (both single and multiple) and transient LOS relaxations (TLOSRs) were identified and the characteristics of these events defined. Reflux was identified with manometric criteria (common cavity episodes). RESULTS: Five hundred and eleven relaxation of the LOS were observed, 55% related to single swallows, 23% related to multiple swallows, and 22% TLOSRs. The time to maximal LOS relaxation was longer for TLOSRs than for single or multiple swallows (mean (SEM) 5.0 (0.3) s v 3.0 (0.1) s and 3.3 (0.1) s, p < 0.0001 and p < 0.005). The durations of multiple swallows and TLOSRs were longer than single swallows (12.2 (0.5) s and 11.2 (0.4) s v 5.3 (0.2) s, p < 0.0001). Most of the oesophageal body common cavity episodes (94%) occurred during TLOSRs. CONCLUSIONS: In healthy preterm infants (postmenstrual age > or = 33 weeks) the motor events associated with LOS relaxation were similar to those seen in healthy adults. TLOSRs may be an important mechanism of reflux in premature infants.

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Selected References

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  1. Boix-Ochoa J., Canals J. Maturation of the lower esophagus. J Pediatr Surg. 1976 Oct;11(5):749–756. doi: 10.1016/0022-3468(76)90099-3. [DOI] [PubMed] [Google Scholar]
  2. Cucchiara S., Bortolotti M., Minella R., Auricchio S. Fasting and postprandial mechanisms of gastroesophageal reflux in children with gastroesophageal reflux disease. Dig Dis Sci. 1993 Jan;38(1):86–92. doi: 10.1007/BF01296778. [DOI] [PubMed] [Google Scholar]
  3. Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976 Aug;71(2):263–267. [PubMed] [Google Scholar]
  4. Dent J., Dodds W. J., Friedman R. H., Sekiguchi T., Hogan W. J., Arndorfer R. C., Petrie D. J. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980 Feb;65(2):256–267. doi: 10.1172/JCI109667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dent J., Holloway R. H., Toouli J., Dodds W. J. Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 1988 Aug;29(8):1020–1028. doi: 10.1136/gut.29.8.1020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dodds W. J., Stewart E. T., Hodges D., Zboralske F. F. Movement of the feline esophagus associated with respiration and peristalsis. An evaluation using tantalum markers. J Clin Invest. 1973 Jan;52(1):1–13. doi: 10.1172/JCI107152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dodds W. J., Stewart E. T., Hogan W. J., Stef J. J., Arndorfer R. C. Effect of esophageal movement on intraluminal esophageal pressure recording. Gastroenterology. 1974 Oct;67(4):592–600. [PubMed] [Google Scholar]
  8. GRYBOSKI J. D., THAYER W. R., Jr, SPIRO H. M. Esophageal motility in infants and children. Pediatrics. 1963 Mar;31:382–395. [PubMed] [Google Scholar]
  9. Gryboski J. D. Suck and swallow in the premature infant. Pediatrics. 1969 Jan;43(1):96–102. [PubMed] [Google Scholar]
  10. Hittner H. M., Hirsch N. J., Rudolph A. J. Assessment of gestational age by examination of the anterior vascular capsule of the lens. J Pediatr. 1977 Sep;91(3):455–458. doi: 10.1016/s0022-3476(77)81324-3. [DOI] [PubMed] [Google Scholar]
  11. Kahrilas P. J., Dodds W. J., Hogan W. J. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988 Jan;94(1):73–80. doi: 10.1016/0016-5085(88)90612-9. [DOI] [PubMed] [Google Scholar]
  12. Koenig W. J., Amarnath R. P., Hench V., Berseth C. L. Manometrics for preterm and term infants: a new tool for old questions. Pediatrics. 1995 Feb;95(2):203–206. [PubMed] [Google Scholar]
  13. MCNALLY E. F., KELLY J. E., Jr, INGELFINGER F. J. MECHANISM OF BELCHING: EFFECTS OF GASTRIC DISTENSION WITH AIR. Gastroenterology. 1964 Mar;46:254–259. [PubMed] [Google Scholar]
  14. Newell S. J., Chapman S., Booth I. W. Ultrasonic assessment of gastric emptying in the preterm infant. Arch Dis Child. 1993 Jul;69(1 Spec No):32–36. doi: 10.1136/adc.69.1_spec_no.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Newell S. J., Sarkar P. K., Durbin G. M., Booth I. W., McNeish A. S. Maturation of the lower oesophageal sphincter in the preterm baby. Gut. 1988 Feb;29(2):167–172. doi: 10.1136/gut.29.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Omari T. I., Miki K., Fraser R., Davidson G., Haslam R., Goldsworthy W., Bakewell M., Kawahara H., Dent J. Esophageal body and lower esophageal sphincter function in healthy premature infants. Gastroenterology. 1995 Dec;109(6):1757–1764. doi: 10.1016/0016-5085(95)90741-6. [DOI] [PubMed] [Google Scholar]
  17. Omari T., Bakewell M., Fraser R., Malbert C., Davidson G., Dent J. Intraluminal micromanometry: an evaluation of the dynamic performance of micro-extrusions and sleeve sensors. Neurogastroenterol Motil. 1996 Sep;8(3):241–245. doi: 10.1111/j.1365-2982.1996.tb00263.x. [DOI] [PubMed] [Google Scholar]
  18. Orenstein S. R. Gastroesophageal reflux. Curr Probl Pediatr. 1991 May-Jun;21(5):193–241. doi: 10.1016/0045-9380(91)90066-t. [DOI] [PubMed] [Google Scholar]
  19. Schoeman M. N., Tippett M. D., Akkermans L. M., Dent J., Holloway R. H. Mechanisms of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology. 1995 Jan;108(1):83–91. doi: 10.1016/0016-5085(95)90011-x. [DOI] [PubMed] [Google Scholar]
  20. Sivri B., Mittal R. K. Reverse-perfused sleeve: an improved device for measurement of sphincteric function of the crural diaphragm. Gastroenterology. 1991 Oct;101(4):962–969. doi: 10.1016/0016-5085(91)90722-w. [DOI] [PubMed] [Google Scholar]
  21. Stevenson R. D., Allaire J. H. The development of normal feeding and swallowing. Pediatr Clin North Am. 1991 Dec;38(6):1439–1453. doi: 10.1016/s0031-3955(16)38229-3. [DOI] [PubMed] [Google Scholar]
  22. Trifan A., Shaker R., Ren J., Mittal R. K., Saeian K., Dua K., Kusano M. Inhibition of resting lower esophageal sphincter pressure by pharyngeal water stimulation in humans. Gastroenterology. 1995 Feb;108(2):441–446. doi: 10.1016/0016-5085(95)90072-1. [DOI] [PubMed] [Google Scholar]
  23. Werlin S. L., Dodds W. J., Hogan W. J., Arndorfer R. C. Mechanisms of gastroesophageal reflux in children. J Pediatr. 1980 Aug;97(2):244–249. doi: 10.1016/s0022-3476(80)80482-3. [DOI] [PubMed] [Google Scholar]

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