Introduction Abnormal oesophageal motility is common after oesophageal atresia (OA) repair and often lead to range of symptoms such as dysphagia, regurgitation and gastro oesophageal reflux. High resolution oesophageal impedance manometry (HROIM) is the gold standard to investigation oesophageal motility and bolus transit. We aimed to characterise patterns of oesophageal dysmotility and frequency of incomplete bolus transit in children with repaired OA.

Method Retrospective analysis of HROIM from children with repaired OA. 5 liquid swallows (with dioralyte) were assessed for the following parameters: integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL) and peristalsis pattern (intact, failed, or ineffective). Impedance tracing was used to assess bolus transit (complete when the impedance returned to baseline or incomplete when impedance failed to return to baseline at any sensor). Incomplete bolus transit was the divided into upper, lower of whole oesophagus based on location.

Results Forty-five wet swallows were assessed from 9 patients, 4 (44%) Females. Mean age 10.5 (±4.6) years. All children complained of difficulty in swallowing certain types of solid and/or liquid food. None of the children had intact peristalsis, 5 had ineffective and 4 had failed peristalsis. One child (11%) had a complete bolus transit despite an ineffective peristalsis, 3 (33.3%) had incomplete bolus transit in the whole oesophagus, 4 (44.4%) had incomplete transit in the upper and one (11%) incomplete transit in the lower oesophagus. Mean (±SD) IRP in the failed peristalsis group was 8 (±2.6), and in the ineffective group was 20.8 (±5.1), DCI 703.7 (±476), DL 6 (±1.1) and peristalsis breaks were 6.3 (±2.5)cm.

Conclusion Impaired oesophageal motility appears to be universal in children with repaired oesophageal atresia and dysphagia. Failed (absent) peristalsis and ineffective oesophageal peristalsis are the common types of oesophageal dysmotility. Majority of children (44%) had incomplete bolus transit in the upper oesophagus while a third (33%) had incomplete transit in the whole oesophagus. Only about 10% had complete bolus transit. Children also appear to have a large peristalsis break of over 6 cm possibly contributing to their ineffective oesophageal motility.

HROIM is a valuable tool to characterise oesophageal dysmotility and bolus transit across the oesopahgus in children with repaired oesophageal atresia and can provide clinical guidance and valuable prognostic information to the affected children.