ROLE OF LOWER ESOPHAGEAL SPHINCTER INCOMPETENCE IN RECURRENT PNEUMONIA AFTER REPAIR OF ESOPHAGEAL ATRESIA

Abstract

The cause of recurrent aspiration pneumonia after repair of esophageal atresia (EA) and tracheo-esophageal fistula (TEF) is obscure. In order to explain this occurence we performed esophageal manometry and examined barium esophagrams in eight patients, ages 11 weeks to 20 years, who had undergone repair of EA and TEF. Two patients with repeated aspiration pneumonia, a history of severe regurgitation, and free gastro-esophageal reflux of barium were found to have subnormal lower esophageal sphincter (LES) tone. One of these children's LES pressure was zero mm Hg while the other, who had previously had a Nissen proceedure, was 11 mm Hg with no relaxation after deglutition. Bethanechol, 0.075 mg/kg IM markedly augmented the LES pressure. Ten minutes after drug administration the LES pressure was 35 mm Hg in both patients. Sphincteric relaxation with deglutition was normal. Chronic bethanechol administration has proven effective in the long term therapy of one child. In contrast, six patients with no history of regurgitation and no gastro-esophageal reflux were found to have normal LES function (mean pressure=26.5 mm Hg; range=20-35 mm Hg). We feel that LES incompetence is one of the variably expressed parts of the syndrome EA and TEF that may have an adverse effect on long term prognosis.