Paediatric Gastroenterology Unit, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Am J Gastroenterol. 2010 Feb;105(2):460-7. doi: 10.1038/ajg.2009.656. Epub 2009 Dec 1.
Esophageal high-resolution manometry (EHRM) has evolved rapidly from a research tool to a routine investigation in adult clinical practice. This study proposes and evaluates a standardized EHRM protocol for use in pediatric clinical practice.
Thirty pediatric patients underwent unsedated EHRM. Indications for EHRM were dysphagia, feeding difficulty, or pre-fundoplication assessment. Two 20-channel customized water-perfused silicone catheters, with an outside diameter of 3.8 mm (MuiScientific, Ontario, CA), were used. The catheters had one distal gastric channel, five channels 0.5 cm apart for the e-sleeve, and 14 proximal channels either 1 cm (for children <5 years) or 2 cm apart (for children >5 years). Single wet swallows, multiple rapid swallows (MRS), and solid swallows were systematically studied.
The median age was 10 years (range 6 months-15 years). The esophageal motor findings were normal peristalsis (n=15), peristaltic dysfunction (n=12), achalasia (n=3), and spasm on consumption of solid food (n=2). The distal contractile integral adjusted for esophageal length (DCIa) of patients with peristaltic dysfunction was significantly lower than that of patients without peristaltic dysfunction (P<0.001). On MRS, aperistalsis with lack of esophagogastric junction (EGJ) relaxation was observed in patients with achalasia, and aperistalsis with complete EGJ relaxation was observed in patients with severe peristaltic dysfunction. On consumption of solid food, esophageal spasm associated with bolus impaction was observed in two patients.
This study provides objective information with regard to topography pressure parameters in esophageal motility disorders of childhood while using a standardized EHRM protocol. The new DCIa variable may be useful for the assessment of patients with peristaltic dysfunction.
食管高分辨率测压（EHRM）已从研究工具迅速发展为成人临床常规检查。本研究提出并评估了一种标准化的 EHRM 方案，用于儿科临床实践。
30 例儿科患者接受了无镇静 EHRM。EHRM 的适应证为吞咽困难、喂养困难或术前评估。使用了两根 20 通道定制水灌注硅酮导管，外径 3.8 毫米（MuiScientific，安大略省，CA）。导管有一个远端胃通道，5 个通道间隔 0.5 厘米用于 e-袖套，14 个近端通道间隔 1 厘米（适用于<5 岁的儿童）或 2 厘米（适用于>5 岁的儿童）。系统研究了单次湿吞咽、多次快速吞咽（MRS）和固体吞咽。
中位年龄为 10 岁（范围 6 个月至 15 岁）。食管运动学发现正常蠕动（n=15）、蠕动功能障碍（n=12）、贲门失弛缓症（n=3）和固体食物摄入时痉挛（n=2）。蠕动功能障碍患者的远端收缩积分（DCIa）明显低于无蠕动功能障碍患者（P<0.001）。在 MRS 中，贲门失弛缓症患者出现无食管胃结合部（EGJ）松弛的蠕动缺失，严重蠕动功能障碍患者出现完全 EGJ 松弛的蠕动缺失。在固体食物摄入时，两名患者观察到食管痉挛伴食团嵌塞。
本研究使用标准化 EHRM 方案提供了儿童食管动力障碍的拓扑压力参数的客观信息。新的 DCIa 变量可能对评估蠕动功能障碍患者有用。
