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ESOPHAGEAL MOTILITY (EM) IN BRAIN DAMAGED PATIENTS (PTS)

Oropharyngeal Dysphagia(OPD)is a common feature in PTS with brain damage. We performed esophageal manometry in 13 PTS(mean age:11.3 months)with neurological handicaps ranging from spastic tetraparesis with severe brain atrophy to only moderate psychomotor mental retardation, in order to assess the role of the EM in the mechanism; of the OPD. All 13 PTS complained of swallowing disorders and failure to thrive, 10 also had vomiting and 9 had pulmonary aspiration, too. All 13 but one had Gastroesophageal Reflux(GER)and 8/10 esophagitis. In PTS with severe brain damage(9/13)esophageal manometry showed a marked Upper Esophageal Sphincter(UES)dysmotility(incomplete relaxation and/or incoordinated activity)and an abnormal motility of the proximal esophagus. Symptoms and EM abnormalities were persistent after cure of GER. In PTS with minor neurological signs(4/13)esophageal manometry showed a normal EM and less severe degrees of UES dysmotility. This latter defect and symptomatology were not persistent after 4-12 months follow-up. In conclusion:Difficulty in swallowing, aspiration of food materials and failure to thrive in some PTS with neurological impairement may be caused by disorders of UES and esophageal motility.