SCLERODERMA-LIKE ESOPHAGEAL DISEASE IN CHILDREN BREAST-FED BY MOTHERSWITH SILICONE BREAST IMPLANTS

Objective.-To determine whether breast-fed children of mothers with si licone implants are at increased risk for the development of scleroder malike esophageal involvement compared with children not exposed to si licone implants. Design.-Case-control study. Setting.-Referral-based p ediatric gastroenterology clinic. Patients.-Eleven children (mean age, 6.0 years; range, 1.5 to 13 years; six boys and five girls) referred for abdominal pain who were born to mothers who had silicone breast im plants (eight breast-fed children and three bottle-fed) were compared with 17 patients (mean age, 10.7 years; range, 2 to 18 years; 11 boys and six girls) with abdominal pain who were not exposed to silicone im plants. Methods.-All children underwent esophageal manometry and upper intestinal endoscopy with esophageal biopsy and were tested for antin uclear antibody and autoantibodies to Scl-70, centromere, ribonucleopr otein, Sm, Ro, La, and phospholipid. Results.-Six of the eight breast- fed children from mothers with silicone implants had significantly abn ormal esophageal motility with nearly absent peristalsis in the distal two thirds of the esophagus and decreased lower sphincter pressure. U pper esophageal pressures and motility were normal. Compared with cont rols, the breast-fed children had significantly decreased lower sphinc ter pressure and abnormal esophageal wave propagation. These manometri c abnormalities were not seen in the three bottle-fed children. There was no difference in the expression of autoantibodies in the breast-fe d children compared with the bottle-fed children or controls. Conclusi ons.-A relationship appears to exist between breast-feeding by mothers with silicone implants and abnormal esophageal motility. Studies eval uating larger numbers of children are needed to determine the extent o f the risk.