The Potential Benefits of Applying Recent Advances in Esophageal Motility Testing in Patients with Esophageal Atresia

Abstract

Infants and children with esophageal atresia commonly present with swallowing dysfunction or dysphagia. Dysphagia can lead to a range of significant consequences such as aspiration pneumonia, malnutrition, dehydration, and food impaction. To improve oral intake, the clinical diagnosis of dysphagia in patients with esophageal atresia should focus on both the pharynx and the esophagus. To characterize the complex interactions of bolus flow and motor function between mouth, pharynx, and esophagus, a detailed understanding of normal and abnormal deglutition is required through the use of adequate and objective assessment techniques. As clinical symptoms do not correlate well with conventional assessment methods of motor function such as radiology or manometry but do correlate with bolus flow, the current state-of-the-art diagnosis involves high-resolution manometry combined with impedance measurements to characterize the interplay between esophageal motor function and bolus clearance. Using a novel pressure flow analysis (PFA) method as an integrated analysis method of manometric and impedance measurements, differentiation of patients with impaired esophago-gastric junction relaxation from patients with bolus outflow disorders is clinically relevant. In this, pressure flow matrix categorizing the quantitative PFA measures may be used to make rational therapeutic decisions in patients with esophageal atresia. Through more advanced diagnostics, improved understanding of pathophysiology may improve our patient care by directly targeting the failed biomechanics of both the pharynx and the esophagus.

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

“…[5][6][7][8][9][10] Generalized automatic analysis systems for interpreting bolus transit and clearance assessed by impedance remain lacking, and there are increasing studies trying to identify applicable parameters to assist in the assessment of impedance signals in HRIM in recent years. [11][12][13][14][15][16] Our study firstly combined the signals from both manometers and impedance interpretation in HRIM by calculation of the DCI to EII ratio, which is easy to apply to all types of esophageal peristalsis and bolus clearance patterns during liquid swallow tests of HRIM. We further validated the diagnostic utility for pediatric IEM and significant body weight loss > 10% within 6 months in children.…”

“…Previous studies 2,[11][12][13][14] have shown that subjects with esophageal dysmotility tend to have a low DCI and high EII; therefore, we calculated the DCI to EII (EII1000, EII1250 and EII1500) ratio of each liquid swallow as DCIIR (DCIIR1000, DCIIR1250 and DCIIR1500) in this study. The esophageal impedance integral (EII) below 1500 Ω of this wet swallow was calculated using MATLAB software (version 8.6 R2015b; MathWorks, USA).…”

“…[7][8][9][10] Many parameters have been used to assess bolus transit in HRIM measurement in both adults and children. [11][12][13][14][15] Automated impedance manometry (AIM) analysis, pressure-flow analysis (PFA), and the esophageal impedance integral (EII) ratio were recently reported to be useful parameters for determining the adequacy of bolus transit in the esophagus. [11][12][13][14][15] However, it is difficult to calculate these parameters during swallow events with absent peristalsis, which limit these parameters to be used for the assessment of all kinds of patients, especially in subjects with esophageal hypomotility disorders.…”

“…[11][12][13][14][15] Automated impedance manometry (AIM) analysis, pressure-flow analysis (PFA), and the esophageal impedance integral (EII) ratio were recently reported to be useful parameters for determining the adequacy of bolus transit in the esophagus. [11][12][13][14][15] However, it is difficult to calculate these parameters during swallow events with absent peristalsis, which limit these parameters to be used for the assessment of all kinds of patients, especially in subjects with esophageal hypomotility disorders. [11][12][13][14][15] Since subjects with IEM tend to have a relatively small DCI and large EII during HRIM, [11][12][13][14]16 we assessed the potential diagnostic utilities of the distal contractile-impedance integral ratio (DCIIR) of HRIM for the diagnosis of IEM in children.…”

Sensor Based Automatic Neonate Respiration Monitoring System

“…The main advantage of this proposed method is no care taker and physical attention is required [3] [9]; it implements the automatic monitoring procedure very easily and effectively [10][11] using hardwares. This project considers the performance metrics such as temperature of the body, pulse rate of heart, moisture in the air and baby's movement for evaluation [2] [13]. These statistics datas are provided by devices and analyzed for further response.…”