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Spectrum of esophageal disorders in children with chest pain
M S Glassman1, M S Medow, S Berezin
1Department of Pediatrics, New York Medical College, Valhalla 10595.
Insights
Pediatric chest pain evaluation should include esophageal motility testing. While esophagitis treatment resolves symptoms, esophageal motility disorders are often resistant to therapy.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Motility Disorders
Background:
- Chest pain is a common complaint in children.
- Esophageal dysfunction can be a significant cause of pediatric chest pain.
Purpose of the Study:
- To investigate the role of esophageal manometry and esophagogastroscopy in diagnosing pediatric chest pain.
- To compare treatment outcomes for esophagitis versus esophageal motility disorders in children.
Main Methods:
- Retrospective review of 83 children with chest pain undergoing esophageal manometry and esophagogastroscopy.
- Classification of patients into four groups based on histology and motility.
- Analysis of treatment response after six months.
Main Results:
- 57% of children had normal esophageal histology and motility.
- Esophagitis with normal motility responded well to H2-receptor blockade.
- Abnormal esophageal motility disorders showed poor response to various therapies.
Conclusions:
- Esophageal motility testing and esophagoscopy are crucial for evaluating pediatric chest pain.
- Treatment of esophagitis is effective, but esophageal motility disorders present therapeutic challenges.
Abstract:
The charts of 83 children with chest pain who underwent esophageal manometry followed by esophagogastroscopy were reviewed. Forty-seven (57%) had normal esophageal histology and normal motility (group I). Esophagitis and normal motility were demonstrated in 15 children (group II), normal esophageal histology and esophageal dysmotility in 13 (group III), and both esophagitis and abnormal motility in 8 (group IV). Diffuse esophageal spasm and achalasia were the most common motility disorders identified (in seven and four patients, respectively). The presence and duration of symptoms, the age, and the gender were not different among the four patient groups. After six months of H2-receptor blockade, 12 of 15 group II patients were asymptomatic, whereas a significantly smaller percentage (five of 18) of patients with abnormal esophageal motility responded to esophageal dilation or treatment with calcium channel blockade, H2-receptor antagonist, and/or prokinetic agents (P less than 0.01). These data suggest that the evaluation of children with chest pain should include esophageal motility testing and esophagoscopy, even in the absence of other gastrointestinal-associated symptoms, and that while treatment of esophagitis results in resolution of symptoms, motility disorders were relatively refractory to therapy.