Characteristics of high‐resolution esophageal manometry in children without dysphagia

Abstract

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.

Patterns of Esophageal Motility and Bolus Transit in Children With Repaired Esophageal Atresia

“…For pediatrics normal values, we have used a previously published data. [6][7][8] Bolus transit was assessed using the impedance contour traces to visualize where the bolus remained in the esophageal body either post-peristalsis where present, or post-lower esophageal sphincter (LES) closure where peristalsis failed. IBC was defined as bolus (liquid or solid) entry without bolus clearance at any of the impedance recording sites and is divided into upper, lower and whole failure, dependent on area of incomplete clearance within the esophageal body.…”

“…4 Normal values and result interpretation in adults are based on plethora of evidence 5 but normative values in pediatric HRM are often based on small cohort studies. [6][7][8] In one pediatric study, all children with repaired EA were reported to have had an abnormal HRM findings. 9 Impaired motility can lead to abnormal transit in the esophageal body and/or incomplete bolus clearance (IBC).…”

High-resolution esophageal manometry in children

“…However, in children younger than 2 years, a swallow study can be performed 3 . Normal manometry biometrics are available for 9-16-year-old patients 4 . A normal 5 th -95 th percentile range was published for children <18 years of age 5 .…”

Esophageal motility disorder – has Chicago classification v4.0 simplified our management?

“…Research on pediatric esophagus physiology can inform diagnostic criteria and treatment recommendations tailored to children. Interpretation of manometric data in children currently utilizes parameters derived from adult population [24 ▪ ,25]…”