Role of esophageal manometry in children with refractory gastroesophageal reflux symptoms

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Tzu-Yun Hsing1, I-Jung Tsai1, Chien-Ting Hsu2

  • 1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|June 21, 2019
PubMed

Insights

Children with refractory GER symptoms may have ineffective esophageal motility (IEM). Early diagnosis via esophageal manometry can prevent unnecessary tests and psychological treatments.

Area of Science:

  • Pediatric Gastroenterology
  • Esophageal Motility Disorders
  • Diagnostic Imaging

Background:

  • Ineffective esophageal motility (IEM) is a condition affecting children with gastroesophageal reflux (GER).
  • Diagnosis of IEM can be delayed, leading to extensive investigations.
  • Psychiatric referral is common in children with undiagnosed IEM.

Purpose of the Study:

  • To investigate the prevalence of psychiatric referral and diagnostic procedures in children with IEM.
  • To compare diagnostic pathways for IEM versus GER disease (GERD).

Main Methods:

  • Retrospective analysis of 19 children with refractory GER symptoms undergoing high-resolution esophageal impedance manometry (HRIM).
  • Data collected included age, gender, symptom duration, and prior diagnostic studies (UGI contrast, EGD).
  • Prevalence of psychiatric referral and HRM parameters were analyzed.

Main Results:

  • 73.68% of children were diagnosed with IEM via HRIM.
  • IEM children had a higher rate of misdiagnosis with psychological problems (78.57%) compared to GERD children (20.00%).
  • IEM patients underwent more UGI contrast studies and EGDs before diagnosis.

Conclusions:

  • Esophageal manometry should be considered for children with GER symptoms refractory to 8 weeks of acid suppression.
  • Early diagnosis of IEM can reduce repeat UGI studies, EGDs, and psychological therapy.
  • Accurate diagnosis of IEM is crucial to avoid misdiagnosis and unnecessary treatments.
Abstract

Keywords:
esophagitisgastritisgastroesophageal reflux diseasehigh-resolution esophageal impedance manometryineffective esophageal motility

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