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Effect of esophageal length on high‐resolution manometry metrics: Extension to the neonatal population
Author(s) -
Rayyan Maissa,
Omari Taher,
AbuAssi Rammy,
Allegaert Karel,
Rommel Nathalie
Publication year - 2020
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13800
Subject(s) - medicine , neonatal intensive care unit , population , library science , pharmacy , intensive care , family medicine , pediatrics , intensive care medicine , environmental health , computer science
Dear Editor, The current state-of-the-art diagnosis of esophageal motility disorders is based on esophageal pressure topography (EPT) using the Chicago classification (CCv3.0).1 The proposed standardized approach is based on EPT reference values from adult cohorts. However, without adjusting for esophageal length, the adult reference values will overestimate the prevalence of major motility disorders in pediatric patients.2-4 The optimal form of reference value adjustment for pediatric use remains to be determined as former studies examining ageand size-related trends have been limited by the inclusion of patients with known dysphagia-causing medical diagnoses such as achalasia and esophageal atresia. Furthermore, published datasets do not extend to the infant population for which the appropriate level of adjustment is currently unknown. As part of an ongoing research program, we have acquired esophageal high-resolution manometry (HRM) data in 12 healthy young infants (aged 31-65 days, 10 males). We have been able to compare these data with a cohort of 57 pediatric patients (aged 1-17.4 years, 27 males) referred for HRM. The cohort comprised 35 cases from a previous publication4 and 22 new cases. Patients with esophageal atresia, neuromuscular disease, unequivocal achalasia subtypes, and past antireflux surgery were not included. The following EPT metrics were derived using the Web application Swallow Gateway (swallowgateway.com): 4-second integrated relaxation pressure (IRP4), distal latency (DL), and distal contractile integral (DCI). The esophageal length (from upper esophageal sphincter to esophagogastric junction) of otherwise healthy young infants ranged from 5.7 to 8.6 cm. By using the linear best fit for esophageal length trends seen in the pediatric patients, data derived from infants were found to lie within the predicted continuum (Figure 1). Indeed, we found that after adjustment for esophageal length, the number of infants below the diagnostic cutoff values decreased.