Paediatrics (RCH) - Theses
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ItemUtilising high resolution impedance manometry to diagnose and manage oesophageal dysfunction in children with oesophageal atresia( 2022)Oesophageal atresia is the most common congenital oesophageal abnormality and requires life-saving surgery in the neonatal period. Despite successful surgery, most patients will have ongoing oesophageal dysmotility. Dysmotility in oesophageal atresia is a life-long risk. Dysmotility results in chronic swallowing dysfunction into adulthood – leading to poor food bolus transport, choking, and even death. We are currently unable to reliably predict which patients will develop dysmotility and require oesophageal dilatations. Therefore, clinical management is reactive, rather than proactive. This research seeks to understand the motility patterns in oesophageal atresia, as well as the dilatation burden and late mortality risk. This research utilises high resolution impedance manometry, which provides accurate and reliable measurements of oesophageal wall compliance, to develop an understanding of how compliance relates to food bolus transport. This will allow for objective characterisation of oesophageal contraction in patients with oesophageal atresia. Simultaneously, patient and carer quality of life will also be assessed. With the largest cohort of patients with oesophageal atresia undergoing high resolution impedance manometry internationally, this research demonstrates that the distinct motility patterns of these patients remain consistent over time. This informs patient management and parental counselling, as well as the development of a strategy for predicting and preventing morbidity and mortality in oesophageal atresia.