Etiology of Motility Disorders in EA and CES
The etiology of esophageal dysfunction in cases of CES after repair of EA is complex; it may be due to CES or EA each alone or in combination. An acquired origin and a congenital origin were proposed. An acquired etiology is due to surgical intervention with extensive dissection or injury to vagal nerves. Congenitally, there are abnormal intrinsic and extrinsic nerve supplies in the atretic esophagus. The problem can become more severe when a structural pathology (esophageal stricture or CES) is superimposed on the underlying disordered motility. Clinical evaluation, esophagogram and manometry are used to evaluate the anatomy and motor function of the esophagus and the esophagogastric junction (EGJ). Manometry is the diagnostic tool of choice. Pressure-flow analysis (PFA) was introduced to allow for integrated analysis of simultaneously recorded esophageal motility and bolus flow.
The primary motility disorder is due to abnormal development of the esophageal muscles or to the innervations of the esophagus whether extrinsic or intrinsic. The secondary motility disorder is caused by surgery and GER. The tertiary motility disorder is caused by structural pathology due to anastomotic stricture or CES or peptic stricture due to GER.
KeywordsCongenital esophageal stenosis Esophageal atresia Esophageal motility disorder
- 14.Al-Shraim MM, Ibrahim AHM, Al Malki TA, Morad N. Histopathologic profile of esophageal atresia and tracheoesophageal fistula. Ann Pediatr Surg. 2014;10:1–6. https://doi.org/10.1097/01.XPS.0000438124.55523.06.CrossRefGoogle Scholar
- 16.Boleken M, Demirbilek S, Kirimiloglu H, Hanmaz T, Yucesan S, Celbis O, Uzun I. Reduced neuronal innervation in the distal end of the proximal esophageal atretic segment in cases of esophageal atresia with distal fistula. World J Surg. 2007;31:1512–7. https://doi.org/10.1007/s00268-007-9070-y.CrossRefPubMedGoogle Scholar
- 17.Li K, Zheng S, Xiao X, Wang Q, Zhon Y, Chen L. The structural characteristics and expression of neuropeptides in the esophagus of patients with congenital esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2007;42:1433–8. https://doi.org/10.1016/j.jpedsurg.2007.03.050.CrossRefPubMedGoogle Scholar
- 31.Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(suppl 1):57–65. https://doi.org/10.1111/j.1365-2982.2011.01834.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Van Wijk M, Knuppe F, Omari T, DE long J, Benninga M. Evaluation of gastroesophageal functional mechanisms underlying gastro-esophageal reflux in infants and adults born with esophageal atresia. J Pediatr Surg. 2013;48:2496–505. https://doi.org/10.1016/j.jpedsurg2013.07.024.CrossRefPubMedGoogle Scholar
- 33.Nguyen NQ, Holloway RH, Smout AJ, Omari TI. Automated impedance manometry analysis detects esophageal motor dysfunction in patients who have non-obstructive dysphagia with normal manometry. Neurogastroenterol Motil. 2013;25(3):238–45, e.164. https://doi.org/10.1111/nmo.12040.CrossRefPubMedGoogle Scholar
- 34.Myers JC, Nguyen NQ, Jamieson GG, Van’t Hek JE, Ching K, Holloway RH, et al. Susceptibility to dysphagia after fundoplication revealed by novel automated impedance manometry analysis. Neurogastroenterol Motil. 2012;24(9):812–e393. https://doi.org/10.1111/j.1365-2982.2012.01938.x.CrossRefPubMedGoogle Scholar
- 36.Ibrahim AHM, Bazeed MF, Jamil S, Hamad HA, Abdel Raheem IM, Ashraf I. Management of congenital esophageal stenosis associated with esophageal atresia and its impact on postoperative esophageal stricture. Ann Pediatr Surg. 2016;12:36–4. https://doi.org/10.1097/01.XPS.0000482656.06000.84.CrossRefGoogle Scholar