J Pediatr Gastroenterol Nutr 2019 Mar 5. Epub 2019 Mar 5.
Department of Neurosciences, Experimental Oto-Rhino-Laryngology, Deglutology, KU Leuven, Belgium.
Objectives: To characterize esophageal motility and esophago-gastric junction (EGJ) function in infants who underwent repair of an isolated congenital diaphragmatic hernia (iCDH).
Methods: High Resolution Manometry with impedance was used to investigate esophageal motility and EGJ function after diaphragmatic repair in 12 infants with iCDH (11 left-sided; 9 patch repair). They had esophageal motility studies during neonatal admission (n = 12), at 6 months (n = 10) and at 12 months of life (n = 7). Swallows were analyzed using conventional esophageal pressure topography and pressure-flow analysis and were compared with 11 healthy preterm born infants at near-term age.
Results: Esophageal peristaltic motor patterns in iCDH patients were comparable to controls. EGJ end-expiratory pressure was higher in patients with patch repair versus controls (p = 0.050) and those without patch (p = 0.009). The difference between inspiratory and expiratory pressures at the EGJ was lower in iCDH patients with patch (p = 0.045) compared to patients without. iCDH patients with patch showed increased Pressure Flow Index (PFI), resistance of bolus flow at the EGJ, compared to controls (p = 0.043).
Conclusions: Normal esophageal wave patterns are present in the investigated patients with iCDH. EGJ end-expiratory pressure seems lower in iCDH patients without patch suggesting a decreased EGJ barrier function hence increased vulnerability to gastro-esophageal reflux. Patch repair appears to increase end-expiratory pressure at the EGJ above that of controls suggesting that patch surgery tightens the EGJ, thereby increasing flow resistance. This is in line with the increased PFI. In infants with a patch, the inspiration-expiration pressure difference is lower, reflecting diminished activity of the crural diaphragm.