Clinical Experience With Performing Esophageal Function Testing in Children
Marinde van Lennep1, Marin L Leijdekkers1, Jac M Oors2
1Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology.
Insights
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.
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.
Objectives:
Pediatric high-resolution manometry (HRM) and 24-hour pH-impedance with/without ambulatory manometry (pH-MII+/-mano) tests are generally performed using adult-derived protocols. We aimed to assess the feasibility of these protocols in children, the occurrence of patient-related imperfections and their influence on test interpretability.
Methods:
Esophageal function tests performed between 2015 and 2018 were retrospectively analyzed. All tests were subcategorized into uninterpretable or interpretable tests (regardless of occurrence of patient-related imperfections). For HRM, the following patient-related imperfections were scored: patient-related artefacts, multiple swallowing and/or inability to establish baseline characteristics. For pH-MII(+/-mano), incorrect symptom registration and/or premature catheter removal were scored. Results were compared between age-groups (0-3, 4-12, and >12 years).
Results:
In total 106 HRM, 60 pH-MII, and 23 pH-MII-mano could be fully analyzed. Of these, 94.8% HRM, 91.9% pH-MII, and 95.7% pH-MII-mano were interpretable. Overall, HRM contained imperfections in 78.3% overall and in 8/8 (100%) in the youngest age group, 36/42 (85.7%) in 4 to 12 years and in 37/56 (66.1%) in children above 12 years; P = 0.011. These imperfections led to uninterpretable results in 4 HRM (3.8%), of which 3 were in the youngest age group (3/8, 37.5%). Imperfections were found in 10% of pH-MII and 17.4% of pH-MII-mano. These led to uninterpretable results in 5.0% and 4.3%, respectively. No age-effect was found.
Conclusions:
Esophageal function tests in children are interpretable in more than 90% overall. In children under the age of 4 years, all patients had imperfect HRM and 3/8 tests were uninterpretable. HRM in older children and pH-MII+/-mano were interpretable in the vast majority.
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