Characteristics of high-resolution esophageal manometry in children without dysphagia.

Published on Jun 4, 2021in Neurogastroenterology and Motility2.946
· DOI :10.1111/NMO.14184
Karlo Kovacic3
Estimated H-index: 3
(MCW: Medical College of Wisconsin),
Mark Kern36
Estimated H-index: 36
(MCW: Medical College of Wisconsin)
+ 2 AuthorsManu R. Sood17
Estimated H-index: 17
(MCW: Medical College of Wisconsin)
BACKGROUND The absence of high-resolution esophageal manometry (HREM) norms in pediatrics limits the assessment of children with dysphagia. This study aimed to describe HREM parameters in a cohort of children without dysphagia. METHODS Children ages 9-16 years with a negative Mayo Dysphagia Questionnaire screen and normal histologic findings underwent HREM after completion of esophagogastroduodenoscopy. Ten swallows of 5 ml 0.45% saline boluses per subject were captured in supine position. Analyzed data included resting and integrated relaxation pressures (IRP) of lower (LES) and upper (UES) esophageal sphincters, peristaltic contractile integrals, transition zone (TZ) breaks, velocities, and lengths associated with proximal and distal esophagus. KEY RESULTS 33 subjects (15 female) with mean (range) age 12.9 (9-16) years completed the study. Two of 330 analyzed swallows failed. The UES mean resting pressure, and its 0.2 s and 0.8 s IRPs were 48.3 (95% CI 12.9) mmHg, 2.9 (95% CI 1.9) mmHg, and 12.1 (95% CI 2.5) mmHg, respectively. The LES mean resting pressure and its 4 s IRP were 29.0 (95% CI 4.0) mmHg and 9.2 (95% CI 1.3) mmHg. The mean proximal (PCI) and distal (DCI) esophageal contractile integrals were 231 (95% CI 54.8) mmHg-s-cm and 1789.3 (95% CI 323.5) mmHg-s-cm, with mean TZ break 0.5 (95% CI 0.3) cm. CONCLUSIONS & INFERENCES This is the first study to describe HREM parameters in children without dysphagia. Most of the reported measurements were significantly different and less variable from reported adult norms. This emphasizes the need for child-specific catheters, norms, and protocols to define pediatric esophageal motility disorders.
📖 Papers frequently viewed together
7 Citations
10 Citations
#1Alisara Damrongmanee (CMU: Chiang Mai University)H-Index: 1
#2Khalil El-Chammas (Cincinnati Children's Hospital Medical Center)H-Index: 10
Last. Ajay Kaul (Cincinnati Children's Hospital Medical Center)H-Index: 20
view all 6 authors...
BACKGROUND Motor abnormalities of pharyngeal contraction or upper esophageal sphincter (UES) relaxation can lead to swallowing problems. METHODS We reviewed high-resolution esophageal manometry of children ≤18 years and classified into two groups based on the results of videofluoroscopic study of swallow (VFSS), as normal or abnormal. The UES metrics (integrated relaxation pressure [IRP], resting pressure [URP], and nadir pressure [UNP]), as well as peak pharyngeal pressure (velopharyngeal and m...
#1Rena Yadlapati (UCSD: University of California, San Diego)H-Index: 18
#2Peter J. Kahrilas (NU: Northwestern University)H-Index: 122
Last. John E. Pandolfino (NU: Northwestern University)H-Index: 79
view all 52 authors...
Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of es...
11 CitationsSource
#1Pooja LalH-Index: 2
#1Pooja LalH-Index: 5
Last. Scott GabbardH-Index: 11
view all 9 authors...
INTRODUCTION: The shortened esophagus is poorly defined and is determined intraoperatively, as there exists no objective test to identify a shortened esophagus before surgical hiatal hernia repair. We devised a unique manometric esophageal length to height (MELH) ratio to define the presence of a shortened esophagus and examined the role of esophageal length in hiatal hernia recurrence. PATIENTS AND METHODS: A retrospective review identified 254 patients with hiatal hernia who underwent preopera...
1 CitationsSource
#1Maartje Singendonk (UvA: University of Amsterdam)H-Index: 13
#2Lara Ferris (Flinders University)H-Index: 9
Last. Taher Omari (Flinders University)H-Index: 44
view all 13 authors...
Background: High-resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children. Methods: Fif...
6 CitationsSource
#1Norihisa Ishimura (Shimane University)H-Index: 19
#2Shohei Sumi (Shimane University)H-Index: 3
Last. Yoshikazu Kinoshita (Shimane University)H-Index: 61
view all 13 authors...
: Eosinophilic esophagitis (EoE) is an allergic inflammatory disorder that is characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.1,2 Its prevalence has been increasing rapidly in both Western and Asian countries. In Japan, most of the cases of esophageal eosinophilia (EE) are found in an upper endoscopy examination for gastric cancer screening performed during a comprehensive health check-up.3,4 Indeed, we frequently e...
10 CitationsSource
#1Akhilesh Kumar Kasyap (Bir Hospital)H-Index: 1
#2Shiv Kumar Sah (Purbanchal University)H-Index: 3
Last. Sitaram Chaudhary (Bir Hospital)H-Index: 3
view all 3 authors...
Background Gastro esophageal reflux disease (GERD) is a chronic and recurrent disease, and it varies in regions. However, to date, there are no reports available on clinical features and the risk factors for the asymptomatic reflux esophagitis in Nepalese adults. Methods Data were gathered from 142 erosive patients who had undergone endoscopy at Bir Hospital, Kathmandu. Los Angeles classification was used to grade the severity of the disease. Patients were interviewed to find out the presence of...
7 CitationsSource
Background Esophageal high-resolution manometry (HRM) has rapidly gained much popularity worldwide. The Chicago Classification for esophageal motility disorders is based on a set of normative values for key metrics that was obtained using one of the commercially available HRM systems. Thus, it is of great importance to evaluate whether these normative values can be used for other HRM systems as well. Purpose In this review, we describe the presently available HRM systems, the currently known nor...
57 CitationsSource
#1Peter J. Kahrilas (NU: Northwestern University)H-Index: 122
#2Albert J. Bredenoord (NU: Northwestern University)H-Index: 58
Last. John E. Pandolfino (NU: Northwestern University)H-Index: 79
view all 7 authors...
Esophageal high-resolution manometry with esophageal pressure topography (EPT) is now the gold standard to assess esophageal motility disorders. The Chicago Classification categorizes esophageal motility in EPT based on the analysis of ten test swallows conducted in a supine posture. An algorithm is then applied which classifies motility hierarchically as achalasia, motility disorders never observed in controls (absent peristalsis, distal esophageal spasm, jackhammer esophagus) and peristaltic a...
1,021 CitationsSource
#1Maartje Singendonk (Boston Children's Hospital)H-Index: 13
#2Stamatiki KritasH-Index: 17
Last. Taher Omari (Katholieke Universiteit Leuven)H-Index: 44
view all 10 authors...
Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult-derived criteria. As shorter esophageal length and smaller esophago-gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age- and size-adjustment of diagnostic criteria. We evaluated 76 high-resolution solid state impedance-manometry recordings in children referred for manometry (32M; mean age 9 +/- 1 years) and 25 recordin...
33 CitationsSource
#1Sung Hoon Jung (Catholic University of Korea)H-Index: 3
#2Jung Hwan OhH-Index: 16
Last. Sung-Goo KangH-Index: 1
view all 3 authors...
Background/Aims: This study was designed to investigate risk factors related to asymptomatic erosive esophagitis and the natural history of both endoscopic findings and reflux-related symptoms in subjects with asymptomatic erosive esophagitis. Materials and Methods: On a retrospective basis, data were gathered from patients with erosive esophagitis (Los Angeles classification 3 A) who had undergone endoscopic follow-up at St. Vincent Hospital. Data from 313 subjects with erosive esophagitis were...
7 CitationsSource
Cited By0