TY - JOUR
T1 - High-resolution esophageal manometry in pediatrics
T2 - Effect of esophageal length on diagnostic measures
AU - Singendonk, Maartje M.J.
AU - Ferris, Lara F.
AU - McCall, Lisa
AU - Seiboth, Grace
AU - Lowe, Katie
AU - Moore, David
AU - Hammond, Paul
AU - Couper, Richard
AU - Abu-Assi, Rammy
AU - Cock, Charles
AU - Benninga, Marc A.
AU - van Wijk, Michiel P.
AU - Omari, Taher I.
AU - European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network
N1 - This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
PY - 2020/1/1
Y1 - 2020/1/1
N2 -
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
Fifty‐five children (12.3 ± 4.5 years) referred for
HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included.
Studies were performed using the MMS system and a standardized protocol
including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods)
and analyzed via Swallow Gateway (www.swallowgateway.com).
Esophageal distension pressures and swallow latencies were determined
in addition to EGJ resting pressure and standard EPT metrics. Effects of
esophageal length were examined using partial correlation, correcting
for age. Adult‐derived upper limits were adjusted for length using the
slopes of the identified linear equations.
Key Results
Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000).
Shorter length correlated with higher EGJ resting pressure and 4‐s
integrated relaxation pressures (IRP), distension pressures, and shorter
contraction latencies. Ten patients had an IRP above the adult upper
limit. Adjustment for esophageal length reduced the number of patients
with elevated IRP to three.
Conclusions & Inferences
We prospectively confirmed that certain EPT metrics,
as well as potential useful adjunct pressure‐impedance measures such as
distension pressure, are substantially influenced by esophageal length
and require adjusted diagnostic thresholds specifically for children.
AB -
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
Fifty‐five children (12.3 ± 4.5 years) referred for
HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included.
Studies were performed using the MMS system and a standardized protocol
including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods)
and analyzed via Swallow Gateway (www.swallowgateway.com).
Esophageal distension pressures and swallow latencies were determined
in addition to EGJ resting pressure and standard EPT metrics. Effects of
esophageal length were examined using partial correlation, correcting
for age. Adult‐derived upper limits were adjusted for length using the
slopes of the identified linear equations.
Key Results
Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000).
Shorter length correlated with higher EGJ resting pressure and 4‐s
integrated relaxation pressures (IRP), distension pressures, and shorter
contraction latencies. Ten patients had an IRP above the adult upper
limit. Adjustment for esophageal length reduced the number of patients
with elevated IRP to three.
Conclusions & Inferences
We prospectively confirmed that certain EPT metrics,
as well as potential useful adjunct pressure‐impedance measures such as
distension pressure, are substantially influenced by esophageal length
and require adjusted diagnostic thresholds specifically for children.
KW - adjustment
KW - Chicago classification
KW - children
KW - high-resolution esophageal manometry
KW - impedance
UR - http://www.scopus.com/inward/record.url?scp=85073959744&partnerID=8YFLogxK
U2 - 10.1111/nmo.13721
DO - 10.1111/nmo.13721
M3 - Article
C2 - 31569287
AN - SCOPUS:85073959744
SN - 1350-1925
VL - 32
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 1
M1 - e13721
ER -