Abstract:Background & Aims: The role of high resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary GER disease, for whom symptoms of dysphagia to solids were determined pre-and post-operatively and we examined for features that may predict post-operative dysphagia. Methods: Thirteen children (aged 6.8 -15.5 years) undergoing work up prior to 360o Nissen fundoplication were included. A dysphagia score assessed symptoms. A HRIM procedure recorded 5ml liquid, 5ml viscous and 2cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow-index score (PFI) was also derived. Results: Pre-operative PFI was positively correlated with post-operative dysphagia score (PFI viscous bolus r = 0.771, p<0.005 Abbreviations: HRIM, high resolution impedance manometry; GER, gastroesophageal reflux; EGJ, esophago-gastric junction; LES, lower esophageal sphincter; CD, crural diaphragm; TZ, transition zone; CDP, contractile deceleration point; pH-MII, pH with multichannel intraluminal impedance; PPI, proton pump inhibitor; EPT, esophageal pressure topography; IRP4s, 4s integrated relaxation pressure; CFV, contractile front velocity; DCI, distal contractile integral; DL, distal latency; EGJ-CI, EGJ contractile index; DPA, distension pressure during bolus accommodation; DPCT, distension pressure during compartmentalized transport; DPE, distension pressure during esophageal emptying; PFI, pressure-flow-index; IR, impedance ratio; SDL, swallow to distension latency; DCL, distension to contraction latency; RP, ramp pressure; IEM, ineffective esophageal motility; EoE, eosinophilic esophagitis.
Acknowledgements:We thank Mrs G Seiboth, Mrs K Lowe and Ms S Kritas for assistance with performance of HRIM studies and Dr Junko Fujino for assistance with reviewing endoscopy images. • The ability to accurately predict post-operative dysphagia risk is of interest to gastroenterologists. 'Pressure-flow' anomalies may be predictors of dysphagia symptoms following anti-reflux surgery.• Past studies were performed using 'low-resolution' perfusion lower esophageal sphincter sleeve-manometry.2. What are the significant and/or new findings of this study?• Dysphagia symptoms were common in our pediatric GER disease patients who were receiving diagnostic work up for anti-reflux surgery.• Of all parameters evaluated, bolus 'clearing pressures' were most reliably associated with dysphagia symptoms. Results: Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p<0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p<0.005).
Conclusions:In order to mitigate symptoms i...
