Document Detail


Neuromotor markers of esophageal motility in feeding intolerant infants with gastroschisis.
MedLine Citation:
PMID:  18664867     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Feeding problems in neonates with gastroschisis are commonly attributed to foregut dysmotility. However, the dysmotility mechanisms are not well understood. OBJECTIVE: Our aim was to differentiate the pharyngoesophageal motility characteristics in neonates with gastroschisis compared with the controls. Specifically, the characteristics of swallowing, upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) were evaluated during basal state and upon provocation. PATIENTS AND METHODS: Surgically repaired and recovered study infants with persistent feeding difficulties (n = 8; 36 +/- 2 weeks gestational age) and controls (n = 8; 38 +/- 2 weeks gestational age) were evaluated at 40 +/- 2 weeks and 42 +/- 2.5 weeks postmenstrual age, respectively. The basal and adaptive pharyngoesophageal motility characteristics were evaluated using a specially designed esophageal motility catheter with UES and LES sleeves and pneumohydraulic micromanometric water perfusion system at the crib side. Analysis of variance, chi-square, and t tests were applied; data are shown as mean +/- standard deviation, and P < 0.05 was considered significant. RESULTS: Birth weight was less in gastroschisis (P < 0.03, vs controls) and length was less at motility study (P < 0.01, vs controls). The study group (vs controls) needed prolonged respiratory support (21 +/- 23 vs 1 +/- 2 days; P < 0.001) and prolonged gavage feeding (167 +/- 100 vs 9 +/- 16 days; P < 0.01). Compared with the controls, the gastroschisis group had lower frequency (P < 0.05) and poor propagation of spontaneous swallows (P < 0.001), UES relaxation time was shorter (P < 0.05), rate of relaxation was faster (P < 0.001), and esophageal peristaltic propagation velocity was slower (P < 0.05). Upon esophageal provocation with air and liquids, frequency occurrence of the esophageal reflexes was low (P < 0.05) with respect to primary peristalsis, secondary peristalsis, UES contractile reflex, and LES relaxation reflex. CONCLUSIONS: In gastroschisis feeding milestones and respiratory milestones were delayed, basal pharyngoesophageal peristaltic failure was common, adaptive peristaltic reflexes were less frequent and failed to occur, and frequency occurrences of UES and LES responses were impaired. These neuromotor markers may provide clues to define the esophageal motor function abnormalities in infants with an abnormality thought to be limited to the intestine.
Authors:
Sudarshan Rao Jadcherla; Alankar Gupta; Erin Stoner; Soledad Fernandez; Donna Caniano; Colin D Rudolph
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  47     ISSN:  1536-4801     ISO Abbreviation:  J. Pediatr. Gastroenterol. Nutr.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-30     Completed Date:  2008-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  158-64     Citation Subset:  IM    
Affiliation:
Sections of Neonatology, Nationwide Children's Hospital, Columbus, OH 43205, USA. jadcherlas@pediatrics.ohio-state.edu
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MeSH Terms
Descriptor/Qualifier:
Birth Weight / physiology
Case-Control Studies
Deglutition / physiology
Deglutition Disorders / etiology
Electromyography
Esophageal Motility Disorders / diagnosis,  etiology*
Esophageal Sphincter, Lower / physiology*
Esophageal Sphincter, Upper / physiology*
Female
Gastroschisis / physiopathology*
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Male
Manometry
Muscle, Smooth / physiopathology*
Grant Support
ID/Acronym/Agency:
R01 DK 068158/DK/NIDDK NIH HHS; R03 DK 061502/DK/NIDDK NIH HHS

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