Levine J J, Ilowite N T
Division of Pediatric Gastroenterology, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042.
JAMA. 1994 Jan 19;271(3):213-6. doi: 10.1001/jama.1994.03510270059040.
To determine whether breast-fed children of mothers with silicone implants are at increased risk for the development of sclerodermalike esophageal involvement compared with children not exposed to silicone implants.
Case-series [corrected].
Referral-based pediatric gastroenterology clinic.
Eleven children (mean age, 6.0 years; range, 1.5 to 13 years; six boys and five girls) referred for abdominal pain who were born to mothers who had silicone breast implants (eight breast-fed children and three bottle-fed) were compared with 17 patients (mean age, 10.7 years; range, 2 to 18 years; 11 boys and six girls) with abdominal pain who were not exposed to silicone implants.
All children underwent esophageal manometry and upper intestinal endoscopy with esophageal biopsy and were tested for antinuclear antibody and autoantibodies to Scl-70, centromere, ribonucleoprotein, Sm, Ro, La, and phospholipid.
Six of the eight breast-fed children from mothers with silicone implants had significantly abnormal esophageal motility with nearly absent peristalsis in the distal two thirds of the esophagus and decreased lower sphincter pressure. Upper esophageal pressures and motility were normal. Compared with controls, the breast-fed children had significantly decreased lower sphincter pressure and abnormal esophageal wave propagation. These manometric abnormalities were not seen in the three bottle-fed children. There was no difference in the expression of autoantibodies in the breast-fed children compared with the bottle-fed children or controls.
A relationship appears to exist between breast-feeding by mothers with silicone implants and abnormal esophageal motility. Studies evaluating larger numbers of children are needed to determine the extent of the risk.
确定与未接触硅胶植入物的儿童相比，母亲有硅胶植入物的母乳喂养儿童发生硬皮病样食管受累的风险是否增加。
病例系列[校正后]。
基于转诊的儿科胃肠病诊所。
将11名因腹痛前来就诊的儿童（平均年龄6.0岁；范围1.5至13岁；6名男孩和5名女孩）与17名因腹痛前来就诊但未接触硅胶植入物的患者（平均年龄10.7岁；范围2至18岁；11名男孩和6名女孩）进行比较，这些腹痛儿童的母亲均有硅胶乳房植入物（8名母乳喂养儿童和3名人工喂养儿童）。
所有儿童均接受食管测压和上消化道内镜检查及食管活检，并检测抗核抗体以及针对Scl-70、着丝粒、核糖核蛋白、Sm、Ro、La和磷脂的自身抗体。
8名母亲有硅胶植入物的母乳喂养儿童中有6名食管动力明显异常，食管远端三分之二几乎无蠕动，下括约肌压力降低。食管上段压力和动力正常。与对照组相比，母乳喂养儿童的下括约肌压力明显降低，食管波传播异常。这3名人工喂养儿童未出现这些测压异常。母乳喂养儿童与人工喂养儿童或对照组相比，自身抗体表达无差异。
母亲有硅胶植入物的母乳喂养与食管动力异常之间似乎存在关联。需要开展评估更多儿童的研究以确定风险程度。
