Novel Pressure-Impedance Parameters for Evaluating Esophageal Function in Pediatric Achalasia

Maartje M.J. Singendonk, Taher I. Omari, Nathalie Rommel, Michiel P. van Wijk, Marc A. Benninga, Rachel Rosen, Samuel Nurko
2018 Journal of Pediatric Gastroenterology and Nutrition - JPGN  
Objective: In achalasia, absent peristalsis and reduced esophagogastric junction (EGJ) relaxation and compliance underlie dysphagia symptoms. Novel high-resolution impedance manometry (HRIM) variables, i.e. bolus presence time (BPT) and trans-EGJ-bolus flow time (BFT) have been developed to estimate the duration of EGJ opening and trans-EGJ bolus flow. The aim of this study was to evaluate esophageal motor function and bolus flow in children diagnosed with achalasia using these variables.
more » ... se variables. Methods: HRIM recordings from 20 children who fulfilled the Chicago Classification (V3) criteria for achalasia were compared with recordings of 15 children with normal esophageal HRM findings and no other evidence suggestive of achalasia. Matlab-based analysis software was used to calculate BPT and BFT. Results: Both BPT and BFT were significantly reduced in achalasia patients compared to children with normal esophageal motility (BPT 3.3s vs 5.1s p<0.01; BFT 1.4s vs 4.3s p<0.001). BFT was significantly lower than BPT (achalasia difference 1.9s±1.3s, p=0.001 and normal difference 0.9±0.3s, p=0.001). Overall, there was a significant correlation between BPT and BFT (r=0.825, p<0.001). We observed a two-way differentiation of achalasia patients; those in whom the BPT and BFT were proportional, but significantly lower than in patients with normal peristalsis, and those in whom BFT was disproportionately lower than BPT. Conclusions: Calculation of BPT and BFT may help determine whether esophageal bolus transport to the EGJ and/or esophageal emptying through the EGJ are aberrant. For achalasia this may detect flow resistance at the EGJ, potentially improving both diagnosis and objective assessment of therapeutic effects.
doi:10.1097/mpg.0000000000001647 pmid:28604515 fatcat:efascuc54ndwjgrqelt7rp7hyq