Motor function of the esophagus after repair of esophageal atresia and tracheoesophageal fistula.

Eleven patients with previous esophageal atresia repair (TEF) underwent esophageal motility studies and were compared to 10 normal patients. The upper sphincters (UES) in the two groups did not differ in resting pressure, contraction pressure, or coordination. UES relaxation, was 100% in normal patients and 83+/-8% in the TEF patients (p less than 0.05). In the proximal esophagus, 100% of the TEF group showed a normal peristaltic wave, coupled with an abnormal nonperistaltic wave. The normal group did not show this type of contraction. In the middle esophagus, the mean peak pressure of 30.5+/-2.0 mm Hg was greater in controls than the 14.6+/-1.0 in the TEF group (p less than 0.001). Coordination was observed in 97+/-1% of the controls, while present in only 27+/-4% of the TEF patients (p less than 0.001). In the distal 10 cm of esophagus, peak contraction pressures were 43.3+/-1.6 in controls and 21.3+/-1.1 in the TEF group (p less than 0.001). Coordination was 94+/-1% in normal subjects and 66+/-4% in the TEF patients (p less than 0.001). The resting pressure in TEF patients was significantly higher at all three esophageal levels (proximal, mid, distal) than in normal patients. In both groups lower esophageal sphincter function did not show any significant difference, except for closing pressure, which was significantly higher in controls (39.9+/-6.8 mm Hg) than in the TEF groups (21.3+/-3.0 mm Hg) (p less than 0.02). These studies suggest that marked motility abnormalities occur in the repaired esophagus after atresia. These abnormalities are distinctly different from other motor disorders of the esophagus.