Role of esophageal manometry in children with refractory gastroesophageal reflux symptoms

Abstract

Background: We investigated the prevalence of psychiatric referral, frequency of repeat upper gastrointestinal (UGI) contrast studies, and esophagogastroduodenoscopy (EGD) in children with ineffective esophageal motility (IEM) before the confirmation of esophageal dysmotility. Methods: A total of 19 children (nine boys, 10 girls; mean age, 13.80 AE 5.10 years) with symptoms of refractory gastroesophageal reflux (GER) who underwent high-resolution esophageal impedance manometry (HRIM) were enrolled in this retrospective analysis. Refractory GER symptoms were defined as persistent symptoms even under acid-suppression therapy for 8 weeks in this study. Clinical data including age, gender, time from symptom onset to diagnosis, and number of UGI contrast studies and EGD before diagnosis were obtained. HRM parameters and the prevalence of psychiatric referral were also analyzed. Results: There are 14 children (73.68%) diagnosed with IEM by HRIM, and another 5 children (26.32%) diagnosed as GER disease (GERD) by EGD. A significant proportion of IEM children were misdiagnosed with psychological problems compared with the GERD children (78.57% vs 20.00%, P = 0.04). Three IEM children (21.43%) received antipsychotic and antidepressant agents before diagnosis of IEM, and all of them discontinued these medications after diagnosis. IEM children underwent a greater number of UGI contrast studies (1.07 AE 0.92 vs 0.20 AE 0.45; P = 0.02) and EGD (2.36 AE 2.50 vs 0.60 AE 0.55; P = 0.03) before HRM than GERD children. Conclusions: Esophageal manometry for the diagnosis of IEM should be considered in children with GER symptoms refractory to acid-suppression therapy for 8 weeks to avoid repeat UGI contrast studies, EGD, and psychological therapy.

Role of Esophageal High-Resolution Manometry in Pediatric Patients

“…Patients who had IEM and poor bolus clearance on impedance were treated with a trial of prokinetics and/or dietary texture modification. Of the 48 patients who had abnormal manometry results, seven patients also had abnormal results either in their pH-impedance testing [ 5 ] or endoscopy [ 2 ]. In these seven patients, the treatment changes were made based on the results of these other investigations rather than the manometry.…”

“…Dysphagia was the most common indication (80%), while in the remaining two patients, the indication was a history of cyanotic/blue spells in one and suspected unsafe swallow with aspiration risk in the other. All EA patients had abnormal manometry, with esophageal pressurization seen in 50% [ 5 ], aperistalsis in 40% [ 4 ] and one patient (10%) with prior fundoplication had distal peristalsis with evidence of EGJ obstruction. Based on the Chicago classification, 5 (50%) of our EA patients had IEM with evidence of pressurization, four (40%) patients had absent contractility and one patient with prior history of fundoplication had EGJ obstruction.…”

“…However, data on motility, peristalsis and bolus transport in the esophagus is best elucidated using high-resolution manometry (HRM), ideally combined with impedance topography (HRIM) [ 1 2 3 4 ]. Where HRM/HRIM is not available the diagnosis may be delayed, or misdiagnosed, or rarely, the patient may even be referred to psychiatrists [ 5 ]. Therefore, the aim of this study was to determine the clinical utility of HRM and HRIM of esophagus in symptomatic pediatric patients.…”

High-resolution esophageal manometry in children

“…with infective esophageal motility, unnecessary proton pump inhibitor and antidepressant treatment and functional diagnoses can be avoided 32 .…”