High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures

Maartje M.J. Singendonk, Lara F. Ferris, Lisa McCall, Grace Seiboth, Katie Lowe, David Moore, Paul Hammond, Richard Couper, Rammy Abu-Assi, Charles Cock, Marc A. Benninga, Michiel P. van Wijk, Taher I. Omari*, In Association with the European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: High-resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children. Methods: Fifty-five children (12.3 ± 4.5 years) referred for HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included. Studies were performed using the MMS system and a standardized protocol including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods) and analyzed via Swallow Gateway (www.swallowgateway.com). Esophageal distension pressures and swallow latencies were determined in addition to EGJ resting pressure and standard EPT metrics. Effects of esophageal length were examined using partial correlation, correcting for age. Adult-derived upper limits were adjusted for length using the slopes of the identified linear equations. Key Results: Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P =.000). Shorter length correlated with higher EGJ resting pressure and 4-s integrated relaxation pressures (IRP), distension pressures, and shorter contraction latencies. Ten patients had an IRP above the adult upper limit. Adjustment for esophageal length reduced the number of patients with elevated IRP to three. Conclusions & Inferences: We prospectively confirmed that certain EPT metrics, as well as potential useful adjunct pressure-impedance measures such as distension pressure, are substantially influenced by esophageal length and require adjusted diagnostic thresholds specifically for children.

Original languageEnglish
Article numbere13721
JournalNeurogastroenterology and Motility
Issue number1
Publication statusPublished - 1 Jan 2020

Cite this