ESOPHAGEAL DYSMOTILITY IN CHILDREN BREAST-FED BY MOTHERS WITH SILICONE BREAST IMPLANTS - LONG-TERM FOLLOW-UP AND RESPONSE TO TREATMENT

Our aims were to determine the long-term clinical and manometric follo w-up of 11 children with previously documented eosophageal dysmotility , who had been breast-fed by mothers with silicone breast implants, th eir response to prokinetic agents, and to analyze changes in macrophag e activation. Seven of 11 children had subjective clinical improvement . Weight/height ratios remained the same or improved in 9/11. Biopsies at follow-up endoscopy were either normal or demonstrated mild esopha gitis in 8/10. LES and UES pressures and percent propagation were not significantly different at follow-up, while wave amplitude significant ly increased. Following intravenous metoclopramide, LES pressure, perc ent propagation, and wave amplitude significantly increased while UES pressure was unchanged. Urinary neopterin significantly decreased at f ollow-up, while urinary nitrates were unchanged. Esophageal dysmotilit y is chronic in this group of children, suggesting persistent autonomi c nervous system dysfunction. Prokinetic agents may be useful in long- term management. The decreasing urinary neopterin levels suggest that, ultimately, there may be improvement in esophageal motility.