Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
Neurogastroenterol Motil. 2022 Feb;34(2):e14184. doi: 10.1111/nmo.14184. Epub 2021 Jun 4.
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.
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.
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.
儿科中缺乏高分辨率食管测压（HREM）的正常值，限制了对有吞咽困难的儿童的评估。本研究旨在描述无吞咽困难的儿童的 HREM 参数。
9-16 岁的儿童在完成食管胃十二指肠镜检查后，进行了 Mayo 吞咽困难问卷阴性筛查和正常组织学发现的 HREM。每位受试者仰卧位吞咽 5ml 0.45%盐水 10 次。分析的数据包括食管下括约肌（LES）和食管上括约肌（UES）的静息和整体松弛压力（IRP）、蠕动收缩积分、过渡区（TZ）破裂、近端和远端食管的速度和长度。
33 名受试者（15 名女性）完成了研究，平均年龄为 12.9（9-16）岁，330 次吞咽分析中有 2 次失败。UES 的平均静息压力及其 0.2s 和 0.8s 的 IRP 分别为 48.3（95%CI 12.9）mmHg、2.9（95%CI 1.9）mmHg 和 12.1（95%CI 2.5）mmHg。LES 的平均静息压力及其 4s 的 IRP 分别为 29.0（95%CI 4.0）mmHg 和 9.2（95%CI 1.3）mmHg。平均近端（PCI）和远端（DCI）食管收缩积分分别为 231（95%CI 54.8）mmHg-s-cm 和 1789.3（95%CI 323.5）mmHg-s-cm，平均 TZ 破裂为 0.5（95%CI 0.3）cm。
这是第一项描述无吞咽困难儿童 HREM 参数的研究。大多数报告的测量值与成人正常值有显著差异，且变异较小。这强调了需要针对儿童的导管、正常值和方案来定义小儿食管动力障碍。
