The Potential Benefits of Applying Recent Advances in Esophageal Motility Testing in Patients with Esophageal Atresia
21 June 2017
A Very Interesting Read
Infants and children with esophageal atresia commonly present with swallowing dysfunction or dysphagia. Dysphagia can lead to a range of significant consequences such as aspiration pneumonia, malnutrition, dehydration, and food impaction. To improve oral intake, the clinical diagnosis of dysphagia in patients with esophageal atresia should focus on both the pharynx and the esophagus. To characterise the complex interactions of bolus flow and motor function between mouth, pharynx, and esophagus, a detailed understanding of normal and abnormal deglutition is required through the use of adequate and objective assessment techniques. As clinical symptoms do not correlate well with conventional assessment methods of motor function such as radiology or manometry but do correlate with bolus flow, the current state-of-the-art diagnosis involves high-resolution manometry combined with impedance measurements to characterise the interplay between esophageal motor function and bolus clearance. Using a novel pressure flow analysis (PFA) method as an integrated analysis method of manometric and impedance measurements, differentiation of patients with impaired esophago-gastric junction relaxation from patients with bolus outflow disorders is clinically relevant.
Esophageal Atresia With or Without Tracheoesophageal Fistula
Updated: May 12, 2017
A fetus with oesophagal atresia cannot effectively swallow amniotic fluid, especially when TEF is absent. In a fetus with oesophagal atresia and a distal TEF, some amniotic fluid presumably flows through the trachea and down the fistula to the gut. Polyhydramnios may be the result of this change in the recycling of amniotic fluid through the fetus. Polyhydramnios, in turn, may lead to premature labour. The fetus also appears to derive some nutritional benefit from the ingestion of amniotic fluid; thus, fetuses with oesophagal atresia may be small for their gestational age.
The neonate with oesophagal atresia cannot swallow and drools copious amounts of saliva. Aspiration of saliva or milk, if the baby is allowed to suckle, can lead to an aspiration pneumonitis. In a baby with oesophagal atresia and a distal TEF, the lungs may be exposed to gastric secretions. Also, air from the trachea can pass down the distal fistula when the baby cries, strains, or receives ventilation. This condition can lead to an acute gastric perforation, which is often lethal.
Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia– Tracheoesophageal Fistula Patient
31 May 2017
Esophageal dysmotility is almost universal after esophageal atresia (EA) repair and is mainly related to the developmental anomaly of the esophagus. Esophageal dysmotility is involved in the pathophysiology of numerous symptoms and comorbidities associated with EA such as gastroesophageal reflux disease, aspiration and respiratory complications, and symptoms of dysphagia and feeding disorders. High-resolution esophageal manometry (HREM) has facilitated the characterization of the dysmotility, but there is an incomplete correlation between symptoms and manometrical patterns. Impedance coupled to HREM should help to predict the clinical outcome and therefore personalise patient management. Nowadays, the management of esophageal dysmotility in patients with EA is essentially based on treatment of associated inflammation related to peptic or eosinophilic esophagitis.
Following esophageal atresia (EA) repair, motility disorders of the esophagus are almost universal and may lead to gastroesophageal reflux (GER), aspiration, feeding disorders, and dysphagia in the first few months and years of life. Later on, chronic acid exposure of the esophageal mucosa due to abnormal esophageal motility can lead to Barrett’s esophagus and esophageal carcinoma, which are , concern. In this review, we will focus on the definition, pathophysiology, and treatment of esophageal dysmotility in patients operated for EA.
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