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Updated: Nov 3, 2025
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Characteristics of high-resolution esophageal manometry in children without dysphagia
Karlo Kovacic1, Mark Kern2, Louis Pawela1
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
This study establishes high-resolution esophageal manometry (HREM) norms for children without dysphagia. These pediatric HREM parameters differ from adult norms, highlighting the need for child-specific diagnostic tools for esophageal motility disorders.
Area of Science:
- Pediatric Gastroenterology
- Esophageal Physiology
- Diagnostic Imaging
Background:
- High-resolution esophageal manometry (HREM) norms are lacking for pediatric patients.
- This deficiency hinders the accurate assessment of dysphagia in children.
- Establishing normative HREM data is crucial for diagnosing pediatric esophageal motility disorders.
Purpose of the Study:
- To define high-resolution esophageal manometry (HREM) parameters in a cohort of healthy children.
- To provide normative data for pediatric esophageal motility.
- To establish a baseline for comparison in children with dysphagia.
Main Methods:
- Recruited children aged 9-16 years with negative dysphagia screening and normal histology.
- Performed HREM with 5 mL saline bolus swallows in a supine position.
- Analyzed key parameters including sphincter pressures, contractile integrals, and transition zone breaks.
Main Results:
- Described HREM parameters in 33 healthy children (mean age 12.9 years).
- Reported mean resting pressures and integrated relaxation pressures for upper and lower esophageal sphincters.
- Provided normative values for esophageal contractile integrals and transition zone breaks.
Conclusions:
- This is the first study to report HREM parameters in children without dysphagia.
- Pediatric HREM measurements showed significant differences and less variability compared to adult norms.
- Emphasizes the critical need for child-specific HREM catheters, norms, and protocols.
Background:
The absence of high-resolution esophageal manometry (HREM) norms in pediatrics limits the assessment of children with dysphagia. This study aimed to describe HREM parameters in a cohort of children without dysphagia.
Methods:
Children ages 9-16 years with a negative Mayo Dysphagia Questionnaire screen and normal histologic findings underwent HREM after completion of esophagogastroduodenoscopy. Ten swallows of 5 ml 0.45% saline boluses per subject were captured in supine position. Analyzed data included resting and integrated relaxation pressures (IRP) of lower (LES) and upper (UES) esophageal sphincters, peristaltic contractile integrals, transition zone (TZ) breaks, velocities, and lengths associated with proximal and distal esophagus.
Key Results:
33 subjects (15 female) with mean (range) age 12.9 (9-16) years completed the study. Two of 330 analyzed swallows failed. The UES mean resting pressure, and its 0.2 s and 0.8 s IRPs were 48.3 (95% CI 12.9) mmHg, 2.9 (95% CI 1.9) mmHg, and 12.1 (95% CI 2.5) mmHg, respectively. The LES mean resting pressure and its 4 s IRP were 29.0 (95% CI 4.0) mmHg and 9.2 (95% CI 1.3) mmHg. The mean proximal (PCI) and distal (DCI) esophageal contractile integrals were 231 (95% CI 54.8) mmHg-s-cm and 1789.3 (95% CI 323.5) mmHg-s-cm, with mean TZ break 0.5 (95% CI 0.3) cm.
Conclusions & Inferences:
This is the first study to describe HREM parameters in children without dysphagia. Most of the reported measurements were significantly different and less variable from reported adult norms. This emphasizes the need for child-specific catheters, norms, and protocols to define pediatric esophageal motility disorders.
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