MOTOR FUNCTION OF THE ESOPHAGUS AFTER CAUSTIC BURN

During the subacute and chronic phases of esophagitis due to ingestion of a caustic substance, the patient commonly displays stricture, esop hageal rigidity and dysphagia. We used esophageal manometry, radiology , pH monitoring and Tc-99m scintigraphy to investigate esophageal moto r function in 25 children (mean age 24 +/- 7 months) with chronic esop hagitis after second- and/or third-degree caustic bums. The results we re compared with those for a control group of 12 children (mean age 32 +/- 19 months) under surveillance for suspected gastroesophageal refl ux (GER) but for whom this pathology was later ruled out. Seventeen (6 8%) of the lesioned-group children showed esophageal dysfunction as re vealed by monitoring of pH over a 24-hour period. Over this period, th e mean percentage of time with pH below 4 was 19 +/- 10%, the mean num ber of reflux episodes was 48 +/- 52, the mean number of reflux episod es lasting longer than 5 min was 10 +/- 5, and the mean duration of th e longest reflux episode was 51 +/- 21 min. Manometry indicated that, in the lesioned group, an average of 77 +/- 18% of peristaltic naves w ere nonpropulsive, while the mean Esophageal Work Index (number of pro pulsive waves per hour x mean maximum pressure developed during propul sive waves) was 227 +/- 192 units. All of the above means a ere signif icantly different (p < 0.01) from the corresponding control-group mean s. Esophageal strictures were observed in 60%, (15) of the children. I n 2 cases it was minimal, 2 cases moderate and 11 cases had severe str ictures. Tc-99m scintigraphy indicated that esophageal transit was sli ghtly delayed in four, moderately delayed in five and severely delayed in 16 of the lesioned-group subjects. There mas close correspondence between the results of manometry and scintigraphy as regards severity of esophageal dysfunction. These results indicate that motility distur bances and GER are very frequent sequelae of caustic burns of the esop hagus, and should be taken into account when evaluating symptoms and d eciding on the therapeutic strategy (including diet) to be followed.