Characterization of Esophageal Motility in Children with Operated Esophageal Atresia Using High-Resolution Impedance Manometry and Pressure Flow Analysis.

OBJECTIVES Esophageal dysmotility is common in patients with esophageal atresia (EA). High-resolution impedance manometry (HRIM) and Pressure Flow analysis (PFA) allow characterization of biomechanical events that drive bolus flow. The aims were to assess esophageal motility in children with EA, using pressure flow analysis, and to test whether there is a correlation between PFA parameters and symptoms or endoscopic/histologic findings. METHODS HRIM was performed in 16 children with EA (median age 11 years), compared with 13 patient controls (median age 14 years; p=NS vs patients). Wet swallows were analyzed using PFA. Medical charts were reviewed for symptoms and pathology results of the attendant esophagoscopy. EA patients were arbitrarily sub-grouped according to their motility pattern: Group A with presence of distal contraction in ≥ 50% of the swallows and Group B with presence of distal contractions in <50% of the swallows. RESULTS Esophageal peristaltic motor patterns were abnormal in all EA patients. Bolus transport was impaired as shown by the higher impedance Ratio (IR) in EA than in controls (0.47 vs 0.22 p < 0.001). IR was also higher in Group B (n = 8) versus Group A (n = 8) (p < 0.001). Symptoms of dysphagia were not correlated with the PFA measures. Contractile segment impedance (CSI), a marker of mucosal integrity, was significantly lower in the EA group. CONCLUSIONS Bolus transport was severely altered in EA patients but was not predictive of symptoms. The presence of residual distal contractions is associated with a more efficient bolus propulsion.