Esophageal dysmotility elicited by acid perfusion in children with esophagitis
Ganatra, J.V.; Medow, M.S.; Berezin, S.; Newman, L.J.; Glassman, M.; Bostwick, H.E.; Halata, M.; Schwarz, S.M.
American Journal of Gastroenterology 90(7): 1080-1083
1995
ISSN/ISBN: 0002-9270 PMID: 7611201 Document Number: 449166
Objective: To determine the importance of acid reflux-induced dysmotility in the genesis of noncardiac chest pain in children. Method: We performed esophageal manometries during intaesophageal perfusion with 0.9% NaCl or 0.1 N HCl in 19 children (age, 14.5 +- 0.5 yr) with gastroesophageal reflux, biopsy-proven esophagitis, and complaints of at least one episode of chest pain per day. Results: Baseline esophageal motilities were normal in all patients. Eight of 19 children (42%) complained of chest pain during intraesophageal acid perfusion. In three of these eight patients, complaints of chest pain during acid perfusion were temporally associated with "conversion" of previously normal motility patterns to manometric tracings, indicating esophageal dysmotility. Compared with findings during saline perfusion, esophageal acid exposure in these three children resulted in significant increases in both the duration (13.6 +- 4.0 vs 3.2 +- 0.2 s, p lt 0.05) and amplitude (105.2 +- 7.8 vs 61.2 +- 2.1 mm Hg, p lt 0.05) of esophageal contractions during wet swallows. Symptoms of chest pain resolved in all patients after therapy with H2-receptor antagonists. Conclusions: These data represent the first demonstration of acid-induced esophageal dysmotility in children with chest pain and suggest that reflux-induced motor abnormalities contribute to the onset and/or exacerbation of chest pain in pediatric patients with gastroesophageal reflux and esophagitis.