Do children with dysphagia and normal esophageal motility according to Chicago Classification always have "normal" esophageal motility?

Area of Science:

• Pediatric Gastroenterology
• Esophageal Physiology
• Diagnostic Imaging

Background:

• The Chicago Classification (CC) for esophageal motility disorders, based on adult data, is used for diagnosing children via high-resolution esophageal manometry (HREM).
• This study investigates the differences in HREM parameters between children with and without dysphagia using CC criteria.

Purpose of the Study:

• To compare HREM parameters in children with and without dysphagia.
• To evaluate the applicability of adult-derived CC criteria in pediatric populations.
• To identify potential underdiagnosis of esophageal motility disorders in children.

Main Methods:

• Compared HREM metrics in 41 children without dysphagia and 41 with dysphagia (normal CC diagnosis).
• Analyzed parameters included sphincter pressures, contractile integrals, transition zone gaps, distal latency, and esophageal length to height ratio.
• Established 95th percentile normative cutoffs from the non-dysphagia cohort.

Main Results:

• Distal contractile integral (DCI), transition zone (TZ) gap, and manometric esophageal length to height ratio (MELH) showed significant differences between groups (p < 0.05).
• Based on normative cutoffs, 27% of dysphagia patients had abnormal DCI, 15% abnormal TZ gap, and 22% abnormal MELH.
• Proximal contractile integral (PCI) and sphincter pressures were not significantly different.

Conclusions:

• This is the first study comparing HREM parameters in children with and without dysphagia.
• A significant proportion of children with dysphagia may be underdiagnosed using adult CC criteria.
• There is a critical need for universally accepted, child-specific diagnostic protocols and normative data for HREM.