Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children

Abstract

Background/Purpose: Esophageal burns as a result of accidental swallowing of caustic material are seen frequently in children. Severe motor function disorders of the esophagus after caustic burns are already reported covering the late periods. The aim of this study was to detect, follow, and report the clinical results of esophageal motility changes in acute as well as the late periods of caustic esophageal insult and its relation with prognosis in children. Methods: Esophageal motility was studied in 20 children aged 1.5 to 11 years (mean, 3.8). In the study group, motility of the esophagus was investigated on the fifth day of the burn (after decrease of the edema) and repeated at the end of the third month. To standardize the results, the amplitude and the duration of the pressure waves were recorded at 3 cm above the lower esophageal sphincter (LES), and the velocity in the distal esophagus was calculated. Then the mean values of amplitude, duration, and velocity of 15 swallows were obtained for each patient. Results: At the end of the fifth day, peristaltic response of the esophagus to swallowing was followed in 13 patients. Seven patients were able to swallow water, but no peristaltic response was detected. Therefore, the subjects were divided into 2 groups as motility (+) and motility (−), and each were compared with the control group separately. The amplitude of the pressure wave in the motility (−) group was significantly low when compared with the control group. All the subjects in this group had NaOH burns, and development of severe strictures was detected at the endoscopic examinations after 3 weeks. In motility (+) group, no pathologies were detected except significant decrease in the velocity of the peristaltic wave. Eleven of the subjects in this group had acid burns, and 2 had NaOH burns, and, at the follow-up endoscopic examination after 3 weeks, only one acid burn patient had a slight stricture. Motility measurements conducted at the end of the third month showed that the initial motility (−) group had no changes. No peristaltic response was detected after swallowing, and amplitude of the pressure wave measured at the distal esophagus was significantly lower than the controls. However, in the motility (+) group, decrease in the velocity of the peristaltic wave had disappeared, and there were no differences when compared with the control group. Conclusion: It is suggested that the manometric studies of the esophagus give important data about the severity of the initial esophageal injury and have an important role in determining the prognosis. J Pediatr Surg 37:1526-1528. Copyright 2002, Elsevier Science (USA). All rights reserved.