Inhalation (aspiration) pneumonia following experimentally induced disordered motility of the oesophagus.

Abstract

SYNOPSIS Neuromuscular inco-ordination of the oesophagus in infants following repair of tracheo-oesophageal fistula (T.O.F.) is responsible for inhalation of oesophageal content into the airways resulting in pneumonia. In an experimental study disordered motility of the oesophagus was induced surgically in piglets, to see if this premise was valid. Gross disturbance of peristalsis was confirmed both radiographically and by electromanometry. Prolonged retention of barium was seen in the upper oesophagus after a swallow with later reflux into the pharynx but no aspiration was demonstrated during screening. The tracheal contents of these piglets and a control group were therefore studied after the piglets had been fed regularly on milk and other food for weeks following recovery from the operation. The high incidence of fat filled macrophages in tracheal aspirates obtained from the piglets with surgically induced disordered motility of the oesophagus was significant (P < 0.004) compared with the low incidence in the control group, confirming that disordered motility is responsible for inhalation.