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Clinical Experience With Performing Esophageal Function Testing in Children.

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Pediatric esophageal function tests using adult protocols are largely interpretable. High-resolution manometry (HRM) in children under 4 had imperfections, but overall test interpretability remained high.

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Area of Science:

  • Pediatric Gastroenterology
  • Esophageal Physiology
  • Diagnostic Testing

Background:

  • Pediatric esophageal function tests, including high-resolution manometry (HRM) and 24-hour pH-impedance (pH-MII), often use adult protocols.
  • Assessing the feasibility and interpretability of these adult-derived protocols in pediatric populations is crucial for accurate diagnosis.

Purpose of the Study:

  • To evaluate the feasibility of adult-derived high-resolution manometry (HRM) and 24-hour pH-impedance (pH-MII) protocols in children.
  • To determine the occurrence and impact of patient-related imperfections on test interpretability across different pediatric age groups.

Main Methods:

  • Retrospective analysis of esophageal function tests (HRM, pH-MII+/-mano) conducted between 2015 and 2018.
  • Categorization of tests into interpretable or uninterpretable, noting patient-related imperfections like artefacts, swallowing issues, or premature catheter removal.
  • Comparison of results across pediatric age groups: 0-3 years, 4-12 years, and >12 years.

Main Results:

  • Overall interpretability was high: 94.8% for HRM, 91.9% for pH-MII, and 95.7% for pH-MII-mano.
  • HRM showed imperfections in 78.3% of cases, with 100% in the 0-3 year group, but only 3.8% of HRM tests were uninterpretable.
  • pH-MII and pH-MII-mano had lower rates of imperfections (10% and 17.4%) and uninterpretable results (5.0% and 4.3%), with no significant age-related effect on interpretability.

Conclusions:

  • Pediatric esophageal function tests, including HRM and pH-MII, demonstrate high overall interpretability (>90%) even when using adult protocols.
  • While high-resolution manometry (HRM) in very young children (<4 years) frequently shows imperfections, it rarely leads to uninterpretable results.
  • Older children and those undergoing pH-MII+/-mano tests show excellent interpretability, supporting the use of these protocols in pediatric practice.