Skip to main content
SpringerLink
Log in

Effects of sedation on motor function of the refluxing esophagus

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arana J, Tovar JA, Garay J (1986) Abnormal preoperative and postoperative esophageal peristalsis in gastroesophageal reflux. J Pediatr Surg 21: 711–714

    Google Scholar 

  2. Arana J, Tovar JA (1990) Motor efficiency of the refluxing esophagus in basal conditions and after acid challenge. J Pediatr Surg 24: 1049–1054

    Google Scholar 

  3. Arasu TS, Wyllie R, Fitzgerald JF, Franken EA, Siddiqui AR, Lehman GA, Eigen H, Grosfeld JL (1980) Gastroesophageal reflux in infants and children — comparative accuracy of diagnostic methods. J Pediatr 96: 798–803

    Google Scholar 

  4. Berquist WE, Fonkalsrud EW, Ament ME (1981) Effectiveness of Nissen fundoplication for gastroesophageal reflux in children as measured by 24-hour intraesophageal pH metering. J Pediatr Surg 16: 872–875

    Google Scholar 

  5. Boix Ochoa J, Lafuente JM, Gil Vernet JM (1980) Twenty-four hour esophageal monitoring in gastroesophageal reflux. J Pediatr Surg 15: 74–79

    Google Scholar 

  6. Bouchoucha M, Arham P, De Blic J, Scheinmann P, Faverdin C, Hero M, Paupe J, Fermanian J, Pellerin D (1988) Esophageal motility and gastroesophageal reflux in children with chronic respiratory diseases. Pediatr Surg Int 3: 400–406

    Google Scholar 

  7. Castell DO (1975) The lower esophageal sphincter. Physiologic and clinical aspects. Ann Intern Med 93: 390–401

    Google Scholar 

  8. Christie DL, O'Grady LR, Mack DV (1978) Incompetent lower esophageal sphincter and gastroesophageal reflux in recurrent acute pulmonary disease of infancy and childhood. J Pediatr 93: 2327

    Google Scholar 

  9. Christie DL (1979) The acid reflux test for gastroesophageal reflux. J Pediatr 94: 78–81

    Google Scholar 

  10. Euler AR, Ament ME (1977) Value of esophageal manometric studies in the gastroesophageal reflux of infancy. Pediatrics 59: 58–61

    Google Scholar 

  11. Euler AR, Byrne WJ, Ament ME, Fonsalsrud EW, Strobel CT, Siegel SC, Katz RM, Rachelesfsky GS (1979) Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. Pediatrics 63: 47–52

    Google Scholar 

  12. Gryboski JD, Thayer WR, Spiro HM (1963) Esophageal motility in infants and children. Pediatrics 31: 382–395

    Google Scholar 

  13. Gryboski JD (1965) The swallowing mechanism of the neonate. I. Esophageal and gastric motility. Pediatrics 35: 445–452

    Google Scholar 

  14. Hall AW, Moosa AR, Clark J, Cooley GR, Skinner DB (1975) The effects of premedication drugs on the lower oesophageal high pressure zone and reflux status of Rhesus monkeys and man. Gut 16: 347–352

    Google Scholar 

  15. Hillemeier AG, Grill BB, McCallum R, Gryboski J (1983) Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy. Gastroenterology 84: 741–746

    Google Scholar 

  16. Höllwarth ME, Uray E, Pesendorfer P, Rosanelli K, Rosegger H (1986) Esophageal manometry. Pediatr Surg Int 1: 177–183

    Google Scholar 

  17. Izquierdo MA, Tovar JA, Eizaguirre I (1989) L'exposition acide oesophagienne en un seul chiffre: la surface sous la courbe de pH, Chir Pédiatr 30: 1–5

    Google Scholar 

  18. Johnson DG, Herbst JJ, Oliveros MA, Stewart DR (1977) Evaluation of GER surgery in children. Pediatrics 59: 62–68

    Google Scholar 

  19. Kehrer B, Oesch A (1971) Motilitätsstudie des terminalen Oesophagus bei der kindlichen Hiatushernie. Z Kinderchir 10: 345–358

    Google Scholar 

  20. Kehrer B, Oesch A, Bettex M (1972) Manometric studies of esophageal motility in infants with hiatus hernia. J Pediatr Surg 7: 499–504

    Google Scholar 

  21. Kenigsberg K, Aiges H, Alperstein G, Daum F (1981) A unique device to measure lower esophagus sphincter pressure in unsedated infants. J Pediatr Surg 16: 370–373

    Google Scholar 

  22. Koch A, Gass R (1981) Continuous 20–24 hour esophageal pH-monitoring in infancy. J Pediatr Surg 16: 109–113

    Google Scholar 

  23. Koch A (1986) Der gastroösophageale Reflux im Säuglingsalter. Stuttgart, Hippokrates, pp 16–17

  24. Koenig W, Kehrer B, Bettex M (1982) Le sphincter inferieur de l'oesophage chez le nouveau-né: etude manométrique. Chir Pédiatr 23: 357–362

    Google Scholar 

  25. Moroz SP, Espinoza J, Cumming NA, Diamant NE (1976) Lower esophageal sphincter function in children with and without GER. Gastroenterology 71: 236–241

    Google Scholar 

  26. Opie JC, Chaye H, Fraser GC (1987) Fundoplication and pediatric esophageal manometry: actuarial analysis over 7 years. J Pediatr Surg 22: 935–938

    Google Scholar 

  27. Ott DJ, Katz PO, Wu WC (1985) Anti-reflux barrier. In: Castell DO, Wu WC, Ott DJ (eds) GER disease, New York, Futura, pp 50–51

    Google Scholar 

  28. Reyes HM, Ostrovsky E, Radhakrishnan J (1982) Diagnostic accuracy of 3-hr continuous intraluminal pH monitoring of the lower esophagus in the evaluation of gastroesophageal reflux in infancy. J Pediatr Surg 17: 625–631

    Google Scholar 

  29. Shermeta DW, Whitington PF, Seto DS, Haller JA (1977) Lower esophageal sphincter dysfunction in esophageal atresia:nocturnal regurgita tion and aspiration pneumonia. J Pediatr Surg 12: 871–876

    Google Scholar 

  30. Sondheimer JM, Morris BA (1979) Gastroesophageal reflux among severely retarded children. J Pediatr 94: 710–714

    Google Scholar 

  31. Tovar JA, Morras I, Arana J, Garay J, Tapia I: Etude fonctionelle du reflux gastro-oesophagien chez les enfants encéphalopathes. Chir Pédiatr 27: 134–137

  32. Tovar JA, Morras I, Arana J, Garay J, Tapia I (1986) El reflujo gastroesofágico en enfermos neurológicos. An Esp Pediatr 25: 29–34

    Google Scholar 

  33. Tovar JA, Blarduni E, Torrado J, Arana J, Garay J, Tapia I (1988) Acid exposure and reflux esophagitis. Pediatr Surg Int 3: 326–330

    Google Scholar 

  34. Vanderhoof JA, Rapoport PJ, Paxson CL (1978) Manometric diagnosis of lower esophageal sphincter incompetence in the newborn using a single-lumen perfused catheter. Pediatrics 62: 805–808

    Google Scholar 

  35. Werlin SL, Dodds WJ, Hogan WJ, Arndorfer RC (1980) Mechanisms of gastroesophageal reflux in children. J Pediatr 97: 244–249

    Google Scholar 

  36. Willich E (1971) Oesophagusmanometrie im Kindesalter vor und nach Operation der Hiatushernie. Z Kinderchir 10: 333–344

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universidad del País Vasco. Hospital N.S. de Aranzazu, E-20014, San Sebastián, Spain

    J. A. Tovar, J. Arana & I. Tapia

Authors
  1. J. A. Tovar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Arana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Tapia
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Investigation partially supported by a FISSS Grant (87/1605)

Offprint requests to: J. A. Tovar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tovar, J.A., Arana, J. & Tapia, I. Effects of sedation on motor function of the refluxing esophagus. Pediatr Surg Int 5, 418–421 (1990). https://doi.org/10.1007/BF00174339

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00174339

Key words

Search

Navigation