Analysis of fasting antroduodenal manometry in children

Abstract

Antroduodenal manometry has been used to determine the pathophysiology associated with signs and symptoms of gastrointestinal motility disorders. The diagnostic value of antroduodenal manomentry has been limited by the paucity of data from normal children. In this study, we compared antroduodenal manometry findings from 95 patients with symptoms suggesting a gastrointestinal motility disorder to 20 control children. Phase III of the migrating motor complex (MMC) was less frequent in patients (P < 0.05), especially in those who required total parenteral nutrition (P < 0.001), than in controls. Abnormal migration of phase III and short intervals between phase IIIs were more frequent in patients than in controls (P < 0.01 and P < 0.05, respectively). During phase II, persistent low-amplitude contractions and sustained tonic-phasic contraction were found only in parenteral-nutrition-dependent children. Short or prolonged duration of phase III, absence of phase I following phase III, tonic contractions during phase III, low amplitude of phase III contractions in a single recording site and clusters of contractions or prolonged propagating contractions during phase II were not more frequent in patients than in controls. We conclude that there are five manometric features having a clear association with pediatric gastrointestinal motility disorders: (1) absence of phase III of the MMC, (2) abnormal migration of phase III, (3) short intervals between phase III episodes, (4) persistent low-amplitude contractions, and (5) sustained tonic-phasic contractions.

Comparative analysis of phase III migrating motor complexes in stomach and small bowel using wireless motility capsule and antroduodenal manometry

“…The ability of the WMC to detect high amplitude contractions representing MMC may have potential clinical implications. ADM studies confirm that the presence of low amplitude contractions below 20 mmHg during phase III MMC is indicator of motility abnormalities in small bowel 32,33 . Applying the criteria based on the 10th percentile WMC phase III MMC contractions amplitude (27.9 mmHg for stomach and 26.7 mmHg for SB), to determine the sensitivity and specificity of WMC detection of high amplitude contractions representing MMCs, have allowed us to capture physiologically significant contractions.…”

Interobserver variability in antroduodenal manometry

“…Recordings were coded for 20 manometric features (Table 1). Categories were based upon published criteria 1–3 and included final diagnosis (Table 2), and presence and characteristics of the phase III of the MMC. For each item, the option of ‘judgment not possible from this recording’ was available.…”

“…Diagnostic criteria for paediatric antroduodenal manometry (ADM) studies have been published, 1–3 but the impact of these criteria on interobserver variability in interpretation of these studies has not been assessed. In other disciplines involving the interpretation of complex visual data, such as radiology and histopathology, identification of areas of maximal interobserver variation has led to modification of diagnostic criteria and increased reliability 4–9 .…”

Discriminating Pediatric Condition Falsification from Chronic Intestinal Pseudo-Obstruction in Toddlers

“…For interpreting antroduodenal manometry, we used data previously published (Tomomasa, DiLorenzo, Morikawa, Uc, & Hyman, 1996;Uc, Hoon, DiLorenzo, & Hyman, 1987). The presence of the migrating motor complex is associated with the ability to eat (Hyman et al, 1993).…”