Document Detail


Airway obstruction and gastroesophageal reflux: an experimental study on the pathogenesis of this association.
MedLine Citation:
PMID:  8229606     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Gastroesophageal reflux (GER) frequently complicates the clinical course of children suffering from conditions leading to upper airway obstruction (UAO) (choanal atresia, tracheomalacia, esophageal atresia, vascular rings, etc). In an attempt to explore whether partial airway obstruction causes changes in the normal thoracoabdominal pressure gradients, we measured end-inspiratory intrathoracic and intraabdominal pressures in anesthetized rats under spontaneous breathing conditions, after tracheostomy, and under upper airway obstruction induced by tracheal intubation with three progressively narrower cannulae (inner diameters 1.0 mm, 0.5 mm, and 0.2 mm). We also measured the lower esophageal sphincter pressure (LESP) and length (LESL) and calculated the thoracoabdominal end-inspiratory pressure gradient (TAEIPG). Neither LESP nor LESL changed significantly before or after maximal tracheal obstruction (14.3 +/- 6.2 v 18 +/- 7.6 cm H2O [P > .05] and 0.34 +/- 0.09 v 0.41 +/- 0.1 cm H2O [P > .05] respectively) but TAEIPG significantly increased from 5.58 +/- 1.34 cm H2O to 17.62 +/- 4.27 cm H2O (P < .01) under the same conditions, mainly as a result of progressively increasing negative intrathoracic pressures during inspiration. These experiments prove that the powerful thoracoabdominal pressure gradients developed after partial UAO may contribute to the pathogenesis of GER by overcoming the antireflux barrier function. This study points out the convenience of routinely screening for GER all children with airway obstructive conditions, bearing in mind that the reestablishment of normal respiratory conditions should be the primary goal of treatment.
Authors:
W Wang; J A Tovar; I Eizaguirre; P Aldazabal
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  28     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1993 Aug 
Date Detail:
Created Date:  1993-12-10     Completed Date:  1993-12-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  995-8     Citation Subset:  IM    
Affiliation:
Universidad del País Vasco, Hospital N.S. de Aranzazu, San Sebastián, Spain.
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / physiopathology*
Animals
Esophagogastric Junction / physiopathology
Gastroesophageal Reflux / physiopathology*
Hydrostatic Pressure
Male
Rats
Rats, Wistar
Work of Breathing / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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