Motor efficiency of the refluxing esophagus in basal conditions and after acid challenge.

We have investigated manometrically and endoscopically 60 children with extended pH metering-documented gastroesophageal reflux (GER) and a control group of 14 children of comparable ages. In an attempt to simplify the evaluation of esophageal peristalsis, we measured the frequency of propulsive waves (in waves/hour) and their mean pressure (in mm Hg) in the body of the esophagus and multiplied both values to result in one single figure that reflected esophageal motor efficiency (EME) in some way. We performed the tests in basal conditions (EMEB) and after instillation of 5 mL of 0.1 N CIH into the esophageal lumen (EMECIH). In comparison with controls, refluxing children had a lower sphincter pressure (LESP) (14.9 +/- 8 v 11.8 +/- 6.9 mm Hg, P less than 0.05), an increased proportion of nonpropulsive waves (38.8 +/- 29.3% v 68 +/- 27%, P less than 0.001), and a significantly lower EMEB (896.6 +/- 777 v 375 +/- 306, P less than 0.001). These results suggest that both the sphincteric antireflux barrier and esophageal pump can be damaged in GER. There was a weak, but significant, correlation between EMEB and esophagitis grade (rs = -.25, P less than 0.05). Furthermore, esophageal motor response after CIH instillation may have some prognostic value because EMECIH was significantly higher in those of the 52 children followed-up for more than a year who responded to medical treatment (n = 16) than in those in whom medical treatment was a failure (n = 36) (981.2 +/- 617.4 v 460.5 +/- 452.3, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)