Novel Pressure-impedance Parameters for Evaluating Esophageal Function in Pediatric Achalasia

Maartje Singendonk, Taher Omari, Nathalie Rommel, Michiel van Wijk, Marc Benninga, Rachel Rosen, Samuel Nurko

    Research output: Contribution to journalArticlepeer-review

    13 Citations (Scopus)


    Objective: In Achalasia, absent peristalsis and reduced esophagogastric junction (EGJ) relaxation and compliance underlie dysphagia symptoms. Novel high-resolution impedance manometry variables, that is, bolus presence time (BPT) and trans-EGJ-bolus flow time (BFT) have been developed to estimate the duration of EGJ opening and trans-EGJ bolus flow. The aim of this study was to evaluate esophageal motor function and bolus flow in children diagnosed with Achalasia using these variables. Methods: High-resolution impedance manometry recordings from 20 children who fulfilled the Chicago Classification (V3) criteria for Achalasia were compared with recordings of 15 children with normal esophageal highresolution manometry findings and no other evidence suggestive of Achalasia. Matlab-based analysis software was used to calculate BPT and BFT. Results: Both BPT and BFT were significantly reduced in Achalasia patients compared with children with normal esophageal motility (BPT 3.3 s vs 5.1 s P<0.01; BFT 1.4 s vs 4.3 s P<0.001). BFT was significantly lower than BPT (Achalasia difference 1.9 s±1.3 s, P=0.001 and normal difference 0.9±0.3 s, P=0.001). Overall, there was a significant correlation between BPT and BFT (r=0.825, P<0.001). We observed a 2-way differentiation of Achalasia patients; those in whom the BPT and BFT were proportional, but significantly lower than in patients with normal peristalsis, and those in whom BFT was disproportionately lower than BPT. Conclusions: Calculation of BPT and BFT may help determine whether esophageal bolus transport to theEGJ and/or esophageal emptying through the EGJ are aberrant. For Achalasia, this may detect flow resistance at the EGJ, potentially improving both diagnosis and objective assessment of therapeutic effects.

    Original languageEnglish
    Article numberDATE
    Pages (from-to)37-42
    Number of pages6
    JournalJournal of Pediatric Gastroenterology and Nutrition
    Issue number1
    Publication statusPublished - 1 Jan 2018


    • Chicago classification
    • High-resolution impedance manometry
    • Pressure-flow analysis


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