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High-resolution manometry combined with impedance measurements discriminates the cause of dysphagia in children

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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Pressure-flow analysis allows assessing esophageal bolus transport in relation to esophageal pressures. This study aimed to characterize pressure-flow metrics in relation to dysphagia in paediatric patients. We analysed esophageal pressure-impedance recordings of 5 ml liquid and viscous swallows from 35 children (17 M, mean 10.5 ± 0.8 years). Primary indication for referral was gastroesophageal reflux disease (GERD) (9), post-fundoplication dysphagia (5), idiopathic dysphagia (16), trachea-esophageal fistula (2) and other (3). Peristaltic function was assessed using the 20 mmHg iso-contour defect and the timing between bolus pressure and flow was assessed using the Pressure Flow Index, a metric elevated in relation to dysphagia. Patients were stratified in relation to dysphagia and to peristaltic defect size. Dysphagia was characterized by a weaker peristalsis for liquids and higher Pressure Flow Index for viscous. When patients were stratified based on weak or normal peristalsis, dysphagia with weak peristalsis related to a larger iso-contour defect size and dysphagia with normal peristalsis related to higher Pressure Flow Index.

Conclusion: Pressure-flow analysis enables differentiation of patients with dysphagia due to weak peristalsis (poor bolus clearance) from abnormal bolus flow resistance (esophageal outflow obstruction). This new dichotomous categorization of esophageal function may help guide the selection of optimal treatment such as pharmacological or endoscopic therapy.

What is Known:

• Pressure-flow analysis (PFA) can detect abnormalities in esophageal motility using integrated analysis of bolus propulsion and bolus flow during swallowing.

• AIM analysis has recently been reported to be useful in identifying subtle pre-operative esophageal dysfunction in adult patients who developed post-fundoplication dysphagia as well as in patients with non-obstructive dysphagia.

What is New:

• Pressure-flow parameters can distinguish the cause of dysphagia in paediatric patients.

• Combined high-resolution manometry and impedance measurements with pressure-flow analysis can differentiate paediatric patients with dysphagia symptoms in relation to either weak peristalsis (poor bolus clearance) or over-pressurization (abnormal bolus flow resistance).

How might it impact on clinical practice in the future?

• This study supports the use of a novel objective analysis method on recordings that are readily used in paediatric clinical practice.

• The pressure-flow approach allows discriminating esophageal dysfunction in relation to dysphagia symptoms in children. This has not been achieved in children with current analysis methods.

• The new findings of this study allow a dichotomous categorization of esophageal function, which may help to guide the selection of the most optimal treatment such as pharmacological or endoscopic therapy.

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Abbreviations

AIM:

Automated impedance manometry

EGJ:

Esophago-gastric junction

EPT:

Esophageal pressure topography

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

HRMI:

High-resolution manometry impedance

IBP:

Intrabolus pressure

IBP slope:

Intrabolus pressure slope

ICD:

Iso-contour defect

IRP:

Integrated relaxation pressure

NS:

Not significant

PFI:

Pressure Flow Index

PNI:

Pressure at nadir impedance

PP:

Peak pressure

TNIPP:

Time from nadir impedance to peak pressure

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Authors’ contribution

Nathalie Rommel is responsible for the study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, statistical analysis and study supervision. Taher I. Omari is responsible for the study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision and study supervision. Margot Selleslagh is responsible for the analysis of data and critical revision of the manuscript. Stamatiki Kritas is responsible for the analysis of data and critical revision of the manuscript. Charles Cock is responsible for the critical revision of the manuscript. Rachel Rosan is responsible for the data acquisition and critical revision of the manuscript. Leonel Rodriguez is responsible for the data acquisition and critical revision of the manuscript. Samuel Nurko is responsible for the study concept and design, acquisition, analysis and interpretation of data, critical revision and study supervision.

Conflict of interest

T Omari and N Rommel have AIM technology patent to disclose. None of the other authors have any conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Neurosciences, ExpORL, University of Leuven, Leuven, Belgium

    Nathalie Rommel & Margot Selleslagh

  2. Neurogastroenterology & Motility, Gastroenterology, University Hospital Leuven, Leuven, Belgium

    Nathalie Rommel

  3. Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, Leuven, Belgium

    Nathalie Rommel, Taher I. Omari, Margot Selleslagh & Stamatiki Kritas

  4. School of Medicine, Flinders University, Bedford Park, South Australia, Australia

    Taher I. Omari & Charles Cock

  5. The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia

    Taher I. Omari

  6. Investigation and Procedures Unit, Repatriation General Hospital, Daw Park, South Australia, Australia

    Charles Cock

  7. Harvard Medical School, Boston, MA, USA

    Rachel Rosan, Leonel Rodriguez & Samuel Nurko

  8. Centre for Motility and Functional GI Disorders, Boston Children’s Hospital , Boston, MA, USA

    Rachel Rosan, Leonel Rodriguez & Samuel Nurko

Authors
  1. Nathalie Rommel
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  2. Taher I. Omari
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  3. Margot Selleslagh
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  4. Stamatiki Kritas
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  5. Charles Cock
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  6. Rachel Rosan
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  7. Leonel Rodriguez
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  8. Samuel Nurko
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Corresponding author

Correspondence to Nathalie Rommel.

Additional information

Communicated by Peter de Winter

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Rommel, N., Omari, T.I., Selleslagh, M. et al. High-resolution manometry combined with impedance measurements discriminates the cause of dysphagia in children. Eur J Pediatr 174, 1629–1637 (2015). https://doi.org/10.1007/s00431-015-2582-9

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  • DOI: https://doi.org/10.1007/s00431-015-2582-9

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