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Background The absence of high‐resolution esophageal manometry (HREM) norms in pediatrics limits the assessment of children with dysphagia. This study aimed to describe HREM parameters in a cohort of children without dysphagia. Methods Children ages 9–16 years with a negative Mayo Dysphagia Questionnaire screen and normal histologic findings underwent HREM after completion of esophagogastroduodenoscopy. Ten swallows of 5 ml 0.45% saline boluses per subject were captured in supine position. Analyzed data included resting and integrated relaxation pressures (IRP) of lower (LES) and upper (UES) esophageal sphincters, peristaltic contractile integrals, transition zone (TZ) breaks, velocities, and lengths associated with proximal and distal esophagus. Key Results 33 subjects (15 female) with mean (range) age 12.9 (9–16) years completed the study. Two of 330 analyzed swallows failed. The UES mean resting pressure, and its 0.2 s and 0.8 s IRPs were 48.3 (95% CI 12.9) mmHg, 2.9 (95% CI 1.9) mmHg, and 12.1 (95% CI 2.5) mmHg, respectively. The LES mean resting pressure and its 4 s IRP were 29.0 (95% CI 4.0) mmHg and 9.2 (95% CI 1.3) mmHg. The mean proximal (PCI) and distal (DCI) esophageal contractile integrals were 231 (95% CI 54.8) mmHg‐s‐cm and 1789.3 (95% CI 323.5) mmHg‐s‐cm, with mean TZ break 0.5 (95% CI 0.3) cm. Conclusions & Inferences This is the first study to describe HREM parameters in children without dysphagia. Most of the reported measurements were significantly different and less variable from reported adult norms. This emphasizes the need for child‐specific catheters, norms, and protocols to define pediatric esophageal motility disorders.

Background High‐resolution manometry overcomes limitations imposed by axial and radial asymmetry as well as swallow and respiration‐induced movement of the upper esophageal sphincter (UES), allowing for its reliable use in evaluation of dysphagic and reflux patients. The aim of this study was to determine normative values and their variability across position, sex, age, height, weight, BMI, and volume for clinically relevant deglutitive and non‐deglutitive UES parameters. Methods We studied 89 asymptomatic volunteers age 19–90 years, (45 female) during 3–10 repetitions of dry, 5 and 10 ml water swallows at 30‐s intervals using high‐resolution manometry. Key Results Upper esophageal sphincter high‐pressure zone was longer in men than women and in supine than upright position. UES basal contractile integral and mean basal pressure were higher in supine compared to upright; higher in men than women, inversely correlated with age, correlated positively with height and with weight in the supine position only. UES relaxation duration was longer in upright than in supine position but not affected by age, sex, height, weight, or BMI. It was longer with 5 and 10 ml compared with dry swallows. UES minimum/nadir relaxation and mean relaxation pressures were lower in upright than supine position, increased with increase in age and were higher in men than women. Conclusions and Inferences Position, sex, age, height, weight, and volume affect some deglutitive and non‐deglutitve UES manometric parameters. BMI does not affect the studied manometric parameters. These effects should be taken into consideration in clinical evaluation of UES.

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A 2-year-old male presented to an outside facility with 8-days of decreased intake. Chest X-ray (CXR) revealed a radiopaque object in the upper esophagus suspicious for a battery. The patient was taken for an urgent rigid esophagoscope, no honey or sucralfate was given pre-procedure. Following removal, the posterior mucosal wall was charred with mucosal erosion. No acetic acid irrigation was recorded. The patient was discharged the following day after a normal CXR but no computed tomography (CT) scan. Two months post-removal, the patient was evaluated for recurrent vomiting. Esophagogram showed narrowing in the proximal esophagus and filling defect suspicious for scar tissue or foreign body (Fig. 1). Endoscopy 57 days after initial procedure demonstrated stenosis at the site of prior injury and a 2-cm polyp occluding the lumen (Fig. 2). Hot snare removal was successful, dilation was deferred due to perforation risk. Pathology was consistent with an inflammatory fibroid polyp. Endoscopy 76 days later, showed healed polypectomy site and mild narrowing, which was dilated. Button battery ingestion carries significant risk of morbidity and mortality (1-4). Complications of tissue necrosis, fistula formation, stenosis and perforation are well documented; fibrous polyp formation has not been described (3,4). This case highlights the importance of risk mitigating strategies as described in recent guidelines (1,3,5).

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