Innovative Infant Feeding Disorders Research Program, Nationwide Children's Hospital, Columbus, Ohio, USA.
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.
Physiol Rep. 2022 Jun;10(12):e15366. doi: 10.14814/phy2.15366.
Esophageal distal baseline impedance (DBI) is an indicator of mucosal integrity; lower values suggest increased permeability. Aims were to characterize the (1) effect of DBI category (<900 Ω, 900-2000 Ω, and >2000 Ω) on sensory-motor characteristics of mid-esophageal provocation-induced motility reflexes, and (2) clinical outcomes among high-risk human infants evaluated for gastroesophageal reflux disease. Symptomatic infants (N = 49, 41 ± 3 weeks postmenstrual age) underwent pH-impedance testing to characterize acid reflux index (ARI) and DBI, and pharyngo-esophageal manometry to examine upper esophageal sphincter (UES), peristaltic, and lower esophageal sphincter (LES) functions. Sensory-motor response characteristics included response threshold (ml), occurrence (%), latency (s), duration (s), and magnitude (mmHg) upon mid-esophageal stimulations (0.1-2.0 ml of air, water, and apple juice). Motility and clinical outcomes were compared among DBI groups. In infants with DBI <900 Ω and 900-2000 Ω (vs. >2000 Ω): (a) Long-term feeding milestones did not differ (p > 0.05); (b) complete peristaltic propagation decreased in 900-2000 Ω (p < 0.05), polymorphic waveforms increased in <900 Ω and 900-2000 Ω (p < 0.05); (c) media effects were noted with liquids (vs. air) wherein UES and esophageal contractility were prolonged in <900 Ω and 900-2000 Ω (p < 0.05), and esophageal sensitivity heightened for <900 Ω with water and for 900-2000 Ω with air (both p < 0.05). ARI was not correlated with DBI in infants with chronic lung disease (r = 0.05, p = 0.82). We conclude that pharyngo-esophageal motility sensory-motor characteristics in infants are modified by DBI category. These preliminary findings pave-the-way for further physiological testing in convalescing high-risk infants to ascertain potential mechanisms of airway-digestive reflex interactions and symptom generation, which may lead to targeted therapies.
食管远端基础阻抗（DBI）是黏膜完整性的指标；较低的值表明通透性增加。目的是描述（1）DBI 类别（<900 Ω、900-2000 Ω 和>2000 Ω）对食管中段刺激引起的运动反射的感觉-运动特征的影响，以及（2）评估胃食管反流病高危人类婴儿的临床结果。有症状的婴儿（N=49，41±3 周月经龄）接受 pH-阻抗测试以表征酸反流指数（ARI）和 DBI，并进行咽食管测压以检查上食管括约肌（UES）、蠕动和下食管括约肌（LES）功能。感觉-运动反应特征包括食管中段刺激（0.1-2.0 ml 空气、水和苹果汁）时的反应阈值（ml）、发生率（%）、潜伏期（s）、持续时间（s）和幅度（mmHg）。在 DBI<900 Ω 和 900-2000 Ω 的婴儿中（与>2000 Ω 相比）：（a）长期喂养里程碑没有差异（p>0.05）；（b）900-2000 Ω 中完全蠕动传播减少（p<0.05），<900 Ω 和 900-2000 Ω 中多态波增加（p<0.05）；（c）在液体（与空气相比）中观察到介质效应，其中 UES 和食管收缩性在<900 Ω 和 900-2000 Ω 中延长（p<0.05），并且<900 Ω 时食管敏感性增强，900-2000 Ω 时空气（两者均为 p<0.05）。患有慢性肺部疾病的婴儿中 ARI 与 DBI 无关（r=0.05，p=0.82）。我们得出结论，DBI 类别会改变婴儿咽食管运动的感觉-运动特征。这些初步发现为恢复期高危婴儿的进一步生理测试铺平了道路，以确定气道-消化反射相互作用和症状产生的潜在机制，这可能导致靶向治疗。
