Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size

M M J Singendonk, S Kritas, C Cock, L Ferris, L McCall, N Rommel, M P van Wijk, M A Benninga, D Moore, T I Omari

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult-derived criteria. As shorter esophageal length and smaller esophago-gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age- and size-adjustment of diagnostic criteria.

METHODS: We evaluated 76 high-resolution solid state impedance-manometry recordings in children referred for manometry (32M; mean age 9 ± 1 years) and 25 recordings from healthy adult subjects (7M; mean age 36 ± 2 years). CC metrics; integrated relaxation pressure (IRP4s, mmHg), contractile front velocity (CFV, cm/s), distal contractile integral (DCI, mmHg cm/s), distal latency (DL, s), and peristaltic break size (BS, cm) were derived for 10 liquid swallows using CC analysis software. Effects of age and size were examined using regression analysis.

KEY RESULTS: Younger patient age and shorter size correlated significantly with greater IRP4s (p < 0.05), shorter DL (p < 0.001) and smaller BS (p < 0.05). Standard diagnostic CC criteria were adjusted using the slope of the linear regression equation to define the age/size-related trend. Sixty-six percent of the pediatric cohort showed abnormal motility when applying standard CC criteria. Adjustment for age and size reduced this to 50% and 53% respectively, with the largest reduction being in the IRP4s- and DL-dependent disorders EGJ outflow obstruction and diffuse esophageal spasm (13% to 7% and 5% and 14% to 1 and 5%, respectively).

CONCLUSIONS & INFERENCES: CC metrics, particularly IRP4s and DL, are age and size dependent, and therefore, require adjustment to improve accuracy of diagnosis of esophageal motility disorders in children.

Original languageEnglish
Pages (from-to)1333-41
Number of pages9
JournalNeurogastroenterology and Motility
Volume26
Issue number9
DOIs
Publication statusPublished - Sep 2014

Cite this

Singendonk, M M J ; Kritas, S ; Cock, C ; Ferris, L ; McCall, L ; Rommel, N ; van Wijk, M P ; Benninga, M A ; Moore, D ; Omari, T I. / Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort : effects of patient age and size. In: Neurogastroenterology and Motility. 2014 ; Vol. 26, No. 9. pp. 1333-41.
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title = "Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size",
abstract = "BACKGROUND: Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult-derived criteria. As shorter esophageal length and smaller esophago-gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age- and size-adjustment of diagnostic criteria.METHODS: We evaluated 76 high-resolution solid state impedance-manometry recordings in children referred for manometry (32M; mean age 9 ± 1 years) and 25 recordings from healthy adult subjects (7M; mean age 36 ± 2 years). CC metrics; integrated relaxation pressure (IRP4s, mmHg), contractile front velocity (CFV, cm/s), distal contractile integral (DCI, mmHg cm/s), distal latency (DL, s), and peristaltic break size (BS, cm) were derived for 10 liquid swallows using CC analysis software. Effects of age and size were examined using regression analysis.KEY RESULTS: Younger patient age and shorter size correlated significantly with greater IRP4s (p < 0.05), shorter DL (p < 0.001) and smaller BS (p < 0.05). Standard diagnostic CC criteria were adjusted using the slope of the linear regression equation to define the age/size-related trend. Sixty-six percent of the pediatric cohort showed abnormal motility when applying standard CC criteria. Adjustment for age and size reduced this to 50{\%} and 53{\%} respectively, with the largest reduction being in the IRP4s- and DL-dependent disorders EGJ outflow obstruction and diffuse esophageal spasm (13{\%} to 7{\%} and 5{\%} and 14{\%} to 1 and 5{\%}, respectively).CONCLUSIONS & INFERENCES: CC metrics, particularly IRP4s and DL, are age and size dependent, and therefore, require adjustment to improve accuracy of diagnosis of esophageal motility disorders in children.",
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author = "Singendonk, {M M J} and S Kritas and C Cock and L Ferris and L McCall and N Rommel and {van Wijk}, {M P} and Benninga, {M A} and D Moore and Omari, {T I}",
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Singendonk, MMJ, Kritas, S, Cock, C, Ferris, L, McCall, L, Rommel, N, van Wijk, MP, Benninga, MA, Moore, D & Omari, TI 2014, 'Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size' Neurogastroenterology and Motility, vol. 26, no. 9, pp. 1333-41. https://doi.org/10.1111/nmo.12397

Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort : effects of patient age and size. / Singendonk, M M J; Kritas, S; Cock, C; Ferris, L; McCall, L; Rommel, N; van Wijk, M P; Benninga, M A; Moore, D; Omari, T I.

In: Neurogastroenterology and Motility, Vol. 26, No. 9, 09.2014, p. 1333-41.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Applying the Chicago Classification criteria of esophageal motility to a pediatric cohort

T2 - effects of patient age and size

AU - Singendonk, M M J

AU - Kritas, S

AU - Cock, C

AU - Ferris, L

AU - McCall, L

AU - Rommel, N

AU - van Wijk, M P

AU - Benninga, M A

AU - Moore, D

AU - Omari, T I

N1 - © 2014 John Wiley & Sons Ltd.

PY - 2014/9

Y1 - 2014/9

N2 - BACKGROUND: Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult-derived criteria. As shorter esophageal length and smaller esophago-gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age- and size-adjustment of diagnostic criteria.METHODS: We evaluated 76 high-resolution solid state impedance-manometry recordings in children referred for manometry (32M; mean age 9 ± 1 years) and 25 recordings from healthy adult subjects (7M; mean age 36 ± 2 years). CC metrics; integrated relaxation pressure (IRP4s, mmHg), contractile front velocity (CFV, cm/s), distal contractile integral (DCI, mmHg cm/s), distal latency (DL, s), and peristaltic break size (BS, cm) were derived for 10 liquid swallows using CC analysis software. Effects of age and size were examined using regression analysis.KEY RESULTS: Younger patient age and shorter size correlated significantly with greater IRP4s (p < 0.05), shorter DL (p < 0.001) and smaller BS (p < 0.05). Standard diagnostic CC criteria were adjusted using the slope of the linear regression equation to define the age/size-related trend. Sixty-six percent of the pediatric cohort showed abnormal motility when applying standard CC criteria. Adjustment for age and size reduced this to 50% and 53% respectively, with the largest reduction being in the IRP4s- and DL-dependent disorders EGJ outflow obstruction and diffuse esophageal spasm (13% to 7% and 5% and 14% to 1 and 5%, respectively).CONCLUSIONS & INFERENCES: CC metrics, particularly IRP4s and DL, are age and size dependent, and therefore, require adjustment to improve accuracy of diagnosis of esophageal motility disorders in children.

AB - BACKGROUND: Applying the 2012 Chicago Classification (CC) of esophageal motility disorders to pediatric patients is problematic as it relies upon adult-derived criteria. As shorter esophageal length and smaller esophago-gastric junction (EGJ) diameter may influence CC metrics, we explored the potential for age- and size-adjustment of diagnostic criteria.METHODS: We evaluated 76 high-resolution solid state impedance-manometry recordings in children referred for manometry (32M; mean age 9 ± 1 years) and 25 recordings from healthy adult subjects (7M; mean age 36 ± 2 years). CC metrics; integrated relaxation pressure (IRP4s, mmHg), contractile front velocity (CFV, cm/s), distal contractile integral (DCI, mmHg cm/s), distal latency (DL, s), and peristaltic break size (BS, cm) were derived for 10 liquid swallows using CC analysis software. Effects of age and size were examined using regression analysis.KEY RESULTS: Younger patient age and shorter size correlated significantly with greater IRP4s (p < 0.05), shorter DL (p < 0.001) and smaller BS (p < 0.05). Standard diagnostic CC criteria were adjusted using the slope of the linear regression equation to define the age/size-related trend. Sixty-six percent of the pediatric cohort showed abnormal motility when applying standard CC criteria. Adjustment for age and size reduced this to 50% and 53% respectively, with the largest reduction being in the IRP4s- and DL-dependent disorders EGJ outflow obstruction and diffuse esophageal spasm (13% to 7% and 5% and 14% to 1 and 5%, respectively).CONCLUSIONS & INFERENCES: CC metrics, particularly IRP4s and DL, are age and size dependent, and therefore, require adjustment to improve accuracy of diagnosis of esophageal motility disorders in children.

KW - Adult

KW - Age Factors

KW - Body Size

KW - Child

KW - Cohort Studies

KW - Esophageal Motility Disorders/diagnosis

KW - Female

KW - Humans

KW - Male

KW - Manometry/standards

U2 - 10.1111/nmo.12397

DO - 10.1111/nmo.12397

M3 - Article

VL - 26

SP - 1333

EP - 1341

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

SN - 1350-1925

IS - 9

ER -