Gastrointestinal Dysmotility and the Implications for Respiratory Disease

Abstract

Purpose of the review: Gastroesophageal reflux disease (GERD) is frequently implicated as a cause for respiratory disease. However, there is growing evidence that upper gastrointestinal dysmotility may play a significantly larger role in genesis of respiratory symptoms and development of underlying pulmonary pathology. This paper will discuss the differential diagnosis for esophageal and gastric dysmotility in aerodigestive patients and will review the key diagnostic and therapeutic interventions for this dysmotility.Recent findings: Previous studies have shown an association between GERD and pulmonary pathology in children with aerodigestive disorders. Recent publications have demonstrated the presence of esophageal and gastric dysfunction, using fluoroscopic and nuclear medicine studies, in aerodigestive patients who commonly present to pulmonary and otolaryngology clinics. Highresolution impedance manometry (HRIM) has revolutionized our understanding of esophageal dysmotility and its role in pathogenesis of aspiration and esophageal dysfunction and subsequent respiratory compromise.Summary: Esophageal and gastric dysmotility have a profound effect on development of respiratory symptoms and pulmonary sequalae in aerodigestive patients. However, our understanding of the pathophysiology is in its infancy. Prospective studies in are needed to address key clinical questions such as: What degree of dysmotility initiates respiratory compromise? What diagnostic tests and therapeutic options best predict aerodigestive outcomes?

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

“…inability to or delayed bolus formation, pooling of secretions in the pyriform sinuses etc. ), GER, and regurgitation of foodstuff that is stuck in the esophagus [58][59][60][61] . All of these factors can result in aspiration if the patient is also unable to protect the airways with laryngospasm and/or clear the trachea after laryngeal penetration using cough.…”

What is the role of high‐resolution oesophageal manometry in paediatrics?

“…Oesophageal dysmotility resulting in stasis and direct aspiration can have a profound effect on development of respiratory symptoms and pulmonary sequelae in aerodigestive patients. 18 However, there is a paucity of understanding of the pathophysiology. Prospective studies are needed to address links between oesophageal dysmotility and respiratory compromise.…”

“…The role upper gastrointestinal dysmotility may play in the genesis of respiratory symptoms and development of pulmonary pathology has been under recognised. Oesophageal dysmotility resulting in stasis and direct aspiration can have a profound effect on development of respiratory symptoms and pulmonary sequelae in aerodigestive patients 18 . However, there is a paucity of understanding of the pathophysiology.…”

Aspects of the assessment and management of pharyngoesophageal dysphagia

“…Pediatric manometry studies can provide information where history or symptoms cannot be explained in an infant or child. 22,24 The ability to measure muscle-generated pressures, gradients, and areas of resistance, and then to match that to the bolus flow, be it acid or nonacid, has advanced the understanding of swallowing disorders and offers many avenues for further research. Omari and Cock described the diagnosis of swallowing disorders through HRIM and has designed a platform for the analysis of pharyngeal data (AIMplot).…”

“…Such standardized parameters are now also suggested for the pharynx, to allow a common terminology to be used by clinicians and researchers alike when using this tool to evaluate the pharynx. Pediatric manometry studies can provide information where history or symptoms cannot be explained in an infant or child 22,24 …”