Correlation Between Clinical Signs and High‐resolution Manometry Data in Children

Abstract

Objectives: High-resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. However, clinical signs associated with these disorders are nonspecific, and it is difficult to correlate clinical signs with HRM data. The main objective of our study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of each clinical sign, as well as their sensitivity and specificity in the diagnosis of esophageal motility disorders. Methods: This is a bicentric retrospective cohort study based on HRM data collected between May 2012 and May 2016. The studied symptoms were weight loss, feeding difficulties, swallowing disorders, dysphagia, food blockages, vomiting, gastroesophageal reflux disease (GERD), belching, and respiratory symptoms. HRM data were analyzed according to the Chicago Classification (3.0). Results: In total, 271 HRM data were analyzed, of which 90.4% showed abnormal results. HRM was well tolerated in 91% of the cases. The most common esophageal motility disorder was ineffective esophageal motility (38%). Weight loss was significantly associated (P = 0.003) with an abnormal HRM with a 96% PPV. Conclusions: With nonspecific clinical signs suggesting an esophageal motility disorder, weight loss was a predictive sign of abnormal HRM results. HRM was well tolerated in pediatric patients, and ineffective esophageal motility appears to be the most frequent motility disorder in our cohort, as already observed in adult patient studies.

Role of Esophageal High-Resolution Manometry in Pediatric Patients

“…The majority of our patients had undergone these tests before they were referred for esophagus manometry. Currently, HRM is the gold standard for diagnosis of esophageal dysmotility [ 1 4 17 18 19 ]. HRM gives valuable information about esophageal peristalsis, integrity of contraction and EGJ relaxation pressure.…”

What is the role of high‐resolution oesophageal manometry in paediatrics?

“…[5][6][7][8][9][10] There is an emerging paediatric oesophageal motility literature showing that the spectrum of HRMclassified motility disorders resembles that described for adults. [11][12][13] However, there are still major challenges for standardisation to enable reliable and meaningful results for routine clinical use. Patient size, which impacts oesophageal length and calibre, clearly has a major impact on key oesophageal pressure topography metrics.…”

“…Thus HRM is technically viable in the paediatric setting, even in premature infants 5–10 . There is an emerging paediatric oesophageal motility literature showing that the spectrum of HRM‐classified motility disorders resembles that described for adults 11–13 . However, there are still major challenges for standardisation to enable reliable and meaningful results for routine clinical use.…”

Oesophageal eosinophilia and oesophageal diseases in children: are the limits clear?

“…Oesophageal motility disorders also show a spectrum of symptoms similar to EoE and GERD, including weight loss (non-specific symptom predictive of abnormal HRM), feeding difficulties, dysphagia, vomiting, manifestations of GERD, respiratory symptoms, chest pain, failure to thrive, among others. 20 More non-specific symptoms are described in younger children, such as vomiting, anorexia, chronic cough, which often delays diagnosis. 21 22 In oesophageal motility disorders, allergic disorders have also been reported among the most frequent comorbidities.…”

“… 10 The alterations associated with GERD are dysfunction of the OGJ and alterations in the motility of the oesophageal body, mainly ineffective oesophageal motility. 20 36 37 …”