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van Wijk M.P.,Emma Childrens Hospital | van Wijk M.P.,Center for Pediatric and Adolescent Gastroenterology | Benninga M.A.,Emma Childrens Hospital | Davidson G.P.,Center for Pediatric and Adolescent Gastroenterology | And 4 more authors.
Journal of Pediatrics | Year: 2010

Objective: To investigate the threshold amount of constantly infused feed needed to trigger lower esophageal sphincter relaxation (TLESR) in the right lateral position (RLP) and left lateral position (LLP). Study design: Eight healthy infants (3 male; gestational age: 32.9 ± 2.4 weeks; corrected age: 36.1 ± 1.3 weeks) were studied using an esophageal impedance-manometry catheter incorporating an intragastric infusion port. After tube placement, infants were randomly positioned in RLP or LLP. They were then tube-fed their normal feed (62.5 [40 to 75] mL) at an infusion rate of 160 mL/h. Recordings were made during the feed and 15 minutes thereafter. The study was repeated with the infant in the opposite position. Results: More TLESRs were triggered in the RLP compared with LLP (4.0 [3.0 to 6.0] vs 2.5 [1.0 to 3.0], P = .027). First TLESR occurred at a significantly lower infused volume in RLP compared with LLP (10.6 ± 9.4 vs 21.0 ± 4.9 mL, P = .006). The percentage of feed infused at time of first TLESR was significantly lower in RLP compared with LLP (17.6% ± 15.5% vs 35.4% ± 8.02%, P = .005). Conclusions: In the RLP, TLESRs and gastroesophageal reflux are triggered at volumes unlikely to induce gastric distension. © 2010 Mosby, Inc. All rights reserved.

Van Wijk M.,Emma Childrens Hospital | Knuppe F.,Emma Childrens Hospital | Omari T.,Center for Pediatric and Adolescent Gastroenterology | Omari T.,University of Adelaide | And 2 more authors.
Journal of Pediatric Surgery | Year: 2013

Purpose: To evaluate the mechanisms underlying gastroesophageal reflux (GER) following esophageal atresia (EA) repair and gastroesophageal function in infants and adults born with EA. Methods: Ten consecutive infants born with EA as well as 10 randomly selected adult EA patients were studied during their first postoperative follow-up visit and a purposely planned visit, respectively. A 13C-octanoate breath test and esophageal pH-impedance-manometry study were performed. Mechanisms underlying GER and esophageal function were evaluated. Results: Transient lower esophageal sphincter relaxation (TLESR) was the most common mechanism underlying GER in infants and adults (66% and 62%, respectively). In 66% of all GER episodes, no clearing mechanism was initiated. On EFT, normal motility patterns were seen in six patients (four infants, two adults). One of these adults had normal motility overall (> 80% of swallows). Most swallows (78.8%) were accompanied by abnormal motility patterns. Despite this observation, impedance showed normal bolus transit in 40.9% of swallows. Gastric emptying was delayed in 57.1% of infants and 22.2% of adults. Conclusions: TLESR is the main mechanism underlying GER events in patients with EA. Most infants and adults have impaired motility, delayed bolus clearance, and delayed gastric emptying. However, normal motility patterns were seen in a minority of patients. © 2013 Elsevier Inc. All rights reserved.

van Wijk M.P.,Emma Childrens Hospital | van Wijk M.P.,Center for Pediatric and Adolescent Gastroenterology | Ashley Blackshaw L.,University of Adelaide | Dent J.,University of Adelaide | And 5 more authors.
American Journal of Physiology - Gastrointestinal and Liver Physiology | Year: 2011

Patients with gastroesophageal reflux disease show an increase in esophagogastric junction (EGJ) distensibility and in frequency of transient lower esophageal sphincter relaxations (TLESR) induced by gastric distension. The objective was to study the effect of localized EGJ distension on triggering of TLESR in healthy volunteers. An esophageal manometric catheter incorporating an 8-cm internal balloon adjacent to a sleeve sensor was developed to enable continuous recording of EGJ pressure during distension of the EGJ. Inflation of the balloon doubled the cross-section of the trans-sphincteric portion of the catheter from 5 mm OD (round) to 5 × 11 mm (oval). Ten healthy subjects were included. After catheter placement and a 30-min adaptation period, the EGJ was randomly distended or not, followed by a 45-min baseline recording. Subjects consumed a refluxogenic meal, and recordings were made for 3 h postprandially. A repeat study was performed on another day with EGJ distension status reversed. Additionally, in one subject MRI was performed to establish the exact position of the balloon in the inflated state. The number of TLESR increased during periods of EGJ distension with the effect being greater after a meal [baseline: 2.0(0.0-4.0) vs. 4.0(1.0 -11.0), P = 0.04; postprandial: 15.5(10.0 -33.0) vs. 22.0(17.0 -58.0), P = 0.007 for undistended and distended, respectively]. EGJ distension augments meal-induced triggering of TLESR in healthy volunteers. Our data suggest the existence of a population of vagal afferents located at sites in/around the EGJ that may influence triggering of TLESR. © 2011 the American Physiological Society.

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