ESOPHAGEAL DYSMOTILITY ELICITED BY ACID PERFUSION IN CHILDREN WITH ESOPHAGITIS

Objective: To determine the importance of acid reflux-induced dysmotil ity in the genesis of noncardiac chest pain in children. Method: We pe rformed esophageal manometries during intaesophageal perfusion with 0. 9% NaCl or 0.1 N HCl in 19 children (age, 14.5 +/- 0.5 yr) with gastro esophageal reflux, biopsy-proven esophagitis, and complaints of at lea st one episode of chest pain per day. Results: Baseline esophageal mot ilities were normal in ah patients. Eight of 19 children (42%) complai ned of chest pain during intraesophageal acid perfusion. In three of t hese eight patients, complaints of chest pain during acid perfusion we re temporally associated with ''conversion'' of previously normal moti lity patterns to manometric tracings, indicating esophageal dysmotilit y. Compared with findings during saline perfusion, esophageal acid exp osure in these three children resulted in significant increases in bot h the duration (13.6 +/- 4.0 vs 3.2 +/- 0.2 s,p < 0.05) and amplitude (105.2 +/- 7.8 vs 61.2 +/- 2.1 mm Hg, p < 0.05) of esophageal contract ions during wet swallows. Symptoms of chest pain resolved in all patie nts after therapy with H2-receptor antagonists, Conclusions: These dat a represent the first demonstration of acid-induced esophageal dysmoti lity in children with chest pain and suggest that reflux-induced motor abnormalities contribute to the onset and/or exacerbation of chest pa in in pediatric patients with gastroesophageal reflux and esophagitis.