title: Pediatric esophageal high-resolution manometry: utility of a standardized protocol and size-adjusted pressure topography parameters.
abstract: OBJECTIVE
  Esophageal high-resolution manometry (EHRM) has evolved rapidly from a research tool to a routine investigation in adult clinical practice. This study proposes and evaluates a standardized EHRM protocol for use in pediatric clinical practice.
  
  
  METHODS
  Thirty pediatric patients underwent unsedated EHRM. Indications for EHRM were dysphagia, feeding difficulty, or pre-fundoplication assessment. Two 20-channel customized water-perfused silicone catheters, with an outside diameter of 3.8 mm (MuiScientific, Ontario, CA), were used. The catheters had one distal gastric channel, five channels 0.5 cm apart for the e-sleeve, and 14 proximal channels either 1 cm (for children <5 years) or 2 cm apart (for children >5 years). Single wet swallows, multiple rapid swallows (MRS), and solid swallows were systematically studied.
  
  
  RESULTS
  The median age was 10 years (range 6 months-15 years). The esophageal motor findings were normal peristalsis (n=15), peristaltic dysfunction (n=12), achalasia (n=3), and spasm on consumption of solid food (n=2). The distal contractile integral adjusted for esophageal length (DCIa) of patients with peristaltic dysfunction was significantly lower than that of patients without peristaltic dysfunction (P<0.001). On MRS, aperistalsis with lack of esophagogastric junction (EGJ) relaxation was observed in patients with achalasia, and aperistalsis with complete EGJ relaxation was observed in patients with severe peristaltic dysfunction. On consumption of solid food, esophageal spasm associated with bolus impaction was observed in two patients.
  
  
  CONCLUSIONS
  This study provides objective information with regard to topography pressure parameters in esophageal motility disorders of childhood while using a standardized EHRM protocol. The new DCIa variable may be useful for the assessment of patients with peristaltic dysfunction.
authors: Paediatric Gastroenterology Unit, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Helena A S
authors: HA
authors: Goldani
authors: Annamaria
authors: A
authors: Staiano
authors: Osvaldo
authors: O
authors: Borrelli
authors: Nikhil
authors: N
authors: Thapar
authors: Keith J
authors: KJ
authors: Lindley
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D009119:Muscle Contraction / Q000502:physiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results