An <scp>ANMS</scp>‐<scp>NASPGHAN</scp> consensus document on esophageal and antroduodenal manometry in children

Rosen, Rachel; Garza, Jose M.; Tipnis, Neelesh A.; Nurko, Samuel

doi:10.1111/nmo.13239

Cited by 62 publications

(112 citation statements)

References 90 publications

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“…Our center also does not routinely perform esophageal motility studies, but altered esophageal or pharyngeal motility is found in other disorders such as TEF/EA and cricopharyngeal achalasia in the aerodigestive population. 32 Therapies for such esophageal abnormalities, however, are sparse. 33,34 Despite these limitations, the GI aerodigestive evaluation objectively defined gastrointestinal tract anomalies, evaluated symptom correlation, and found histologic abnormalities.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, this study primarily looked at the reflux evaluation and not the other components of aerodigestive care. Our center also does not routinely perform esophageal motility studies, but altered esophageal or pharyngeal motility is found in other disorders such as TEF/EA and cricopharyngeal achalasia in the aerodigestive population . Therapies for such esophageal abnormalities, however, are sparse …”

Section: Discussionmentioning

confidence: 99%

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Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

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Objective To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH‐MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results Mean patient age was 3.15 years (range 0.15‐24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH‐MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH‐MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH‐MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH‐MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…The ADM study was performed as per previously described protocol . In brief, the study performance was divided into 4 phases: fasting (3‐hour); meal challenge (30‐minute) with postprandial recording (1‐hour); erythromycin (EES) challenge (infusion over 30‐minute and postinfusion recording of 1‐hour); and octreotide (OCT) challenge (1‐hour).…”

Section: Methodsmentioning

confidence: 99%

“…The ADM study was performed as per previously described protocol. 3 In brief, the study performance was divided into 4 phases: The ADM study was performed on two separate days. On day 1, recording began once the patient was fully awake and recovered from anesthesia.…”

Section: Antroduodenal Manometrymentioning

confidence: 99%

Same day versus next day antroduodenal manometry results in children with upper gastrointestinal symptoms: A prospective study

Arbizu

Nurko

Heinz

et al. 2018

Neurogastroenterology Motil

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Background We evaluated the changes in antroduodenal manometry (ADM) parameters and interpretation when the test is performed the day of catheter placement and the following day. Methods Catheter was placed endoscopically under anesthesia and recorded on day 1 and repeated on day 2. Study parameters including antrum and small bowel motility index (MI) during fasting, meal, postprandial, erythromycin (EES), and octreotide (OCT) challenge phases, the presence of the phase III of the migrating motor complex (MMC), visual postprandial response, and study interpretation were compared between both days. Key Results Twenty patients were studied. Antrum and small bowel MI during fasting, postprandial, and EES challenge phases were significantly higher on day 2 than on day 1 (P < 0.05). The proportion of patients having a phase III of the MMC was significantly higher on day 2 compared to day 1 (65% vs 15%; P = 0.006). Study interpretation changed from day 1 to day 2. On day 1, 70% of the patients had a normal study and 30% had an abnormal study. On day 2, 67% of the patients with an abnormal study on day 1 changed to normal and 33% remained abnormal. All patients with a normal study on day 1 remained normal on day 2. Conclusions and Inferences ADM parameters are affected the day of catheter placement. The MI and presence of the phase III of the MMC were significantly higher on day 2 compared to day 1. Overall, ADM study interpretation changed from day 1 to day 2 in 20% of the patients.

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“…Esophageal dysmotility is a rare but troublesome problem in children; however, a prompt diagnosis may lead to adequate timely management. 1 Ineffective esophageal motility disorder (IEM) is one of the esophageal hypomotility disorder, and is associated with dysphagia, chronic vomiting, odynophagia, chest pain, or heartburn sensation. 1 Esophageal high-resolution manometry (HRM) with automated calculated parameters, including distal contractile integral (DCI), distal latency (DL), and 4-s integrated relaxation pressure (IRP-4s) to quantify the intraluminal pressure changes of the esophagus, were developed to assist in the diagnosis of esophageal hypomotility and spastic motor disorders in both adults and children.…”

Section: Introductionmentioning

confidence: 99%

Distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective esophageal motility disorder

Chung

Tseng

et al. 2018

Pediatr Res

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We investigated the diagnostic utility of distal contractile integral (DCI) to esophageal impedance integral (EII) ratio (DCIIR) in high-resolution impedance manometry (HRIM) of ineffective esophageal motility (IEM) in children. METHODS: We performed HRIM in 31 children with dysphagia, odynophagia, chronic vomiting, chest pain, or heartburn sensation. Based on the Chicago classification version 3.0, 20 subjects were diagnosed with IEM, and 11 subjects were normal. We analyzed the EII and DCIIR using MATLAB software. RESULTS: The DCIIR calculated at the impedance cutoff at 1500 Ω (DCIIR1500) were significantly lower in IEM group than patients with normal motility (P = 0.007). Receiver operating characteristic (ROC) curve analysis showed that a DCIIR1500 < 0.009 mmHg/Ω best predicted IEM in children (P < 0.001). A DCIIR1500 < 0.008 mmHg/Ω is associated with significant body weight loss > 10% within 6 months in children. (P < 0.001). CONCLUSIONS: The calculation of DCIIR1500 may assist the automatic analysis of bolus transit in HRIM study to diagnose IEM in children. An DCIIR1500 < 0.009 mmHg/Ω may assist in the diagnosis of IEM in children, and DCIIR1500 < 0.008 mmHg/Ω correlated with significant body weight loss. The calculation of DCIIR may serve as possible parameters for HRIM.

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An ANMS‐NASPGHAN consensus document on esophageal and antroduodenal manometry in children

Cited by 62 publications

References 90 publications

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Same day versus next day antroduodenal manometry results in children with upper gastrointestinal symptoms: A prospective study

Distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective esophageal motility disorder

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