Esophageal Dysfunction

The function of the esophagus, the first organ of the digestive tube, appears very simple: it is an anteroposteriorly flattened hollow tube organ that transports material from the mouth into the stomach. However, this requires a very complex swallowing mechanism, lubrication of the swallowed material with saliva and other esophageal secretions, transport into the stomach by peristaltic waves, and prevention of retrograde transport from stomach to mouth. The esophagus is located in the thoracic cavity and enters the abdominal cavity through an opening in the diaphragm. Although short, the intra-abdominal length of the esophagus is important, because the intra-abdominal pressure will cause compression of this part of the esophagus, preventing reflux. Gastroesophageal reflux (GER), regurgitation, and vomiting are considered to be the most typical, although nonspecific, manifestations of esophageal dysfunction. However, by protecting against excessive postprandial gastric dilatation, GER could also be a feature of normal esophageal function. When GER occurs, nature will try to move any refluxed material that is noxious to the esophageal mucosa out of the esophagus as quickly as possible, both in a downward direction, forcing the refluxed material back into the stomach, and in an upward direction, causing regurgitation and vomiting. Attempts have been made, although with contradictory conclusions (1,2), to evaluate whether the clinical history or a specific questionnaire may be helpful in selecting infants and children with pathologic GER, as has been considered possible in adults (3).