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Manometry

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Gastroesophageal Reflux in Children

Abstract

Esophageal manometry has been in use for physiological measurement and diagnostics for many years. Solid-state high-resolution manometry (HRM) offers the ability to record pressures from the upper esophageal sphincter to the stomach with fidelity and high spatial resolution, and this has led to the definition of new objective biomechanical measures that may guide clinical decision-making in relation to paediatric patients with typical gastroesophageal reflux (GER) disease symptoms. The most important application of HRM is for the preoperative investigation of children undergoing work-up for anti-reflux surgery. Whilst the performance of HRM can be challenging in younger children, HRM can be used to exclude achalasia as a cause of typical symptoms and can provide a range of information on esophageal biomechanics that may be informative for determining disease severity. This includes characterisation of esophageal peristalsis and esophagogastric junction (EGJ) barrier function, based upon EGJ hiatus hernia subtype morphology and EGJ contractility. HRM may potentially have a role for investigation of recurrent transit hold-up symptoms following anti-reflux surgery. Finally, HRM may differentiate GER disease from rumination syndrome.

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References

  1. Singendonk MMJ, Kritas S, Cock C, Ferris L, McCall L, Rommel N, et al. Applying the Chicago classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size. Neurogastroenterol Motil. 2014;26(9):1333–41.

    Article  CAS  PubMed  Google Scholar 

  2. Kahrilas PJ, Bredenoord a J, Fox M, Gyawali CP, Roman S, Smout a JPM, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  PubMed  Google Scholar 

  3. Mauritz FA, Conchillo JM, LWE VH, Siersema PD, CEJ S, RHJ H, et al. Effect and efficacy of laparoscopic fundoplication in children with GERD: The Dutch prospective, multicenter study. Surg Endosc Other Interv Tech. 2016;30:S49. Springer US

    Google Scholar 

  4. Martinucci I, de Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5(2):86–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chan WW, Haroian LR, Gyawali CP. Value of preoperative esophageal function studies before laparoscopic antireflux surgery. Surg Endosc Other Interv Tech. 2011;25:2943–9.

    Article  Google Scholar 

  6. Pandolfino JE, M a K, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526–33.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg. 2015;151(1):1–6.

    Google Scholar 

  8. Singhal V, Khaitan L. Preoperative evaluation of gastroesophageal reflux disease. Surg Clin North Am. 2015;95(3):615–27. Elsevier Inc;

    Article  PubMed  Google Scholar 

  9. Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97. Elsevier Inc;

    Article  PubMed  Google Scholar 

  10. Karamanolis GP, Sifrim D. Patients with refractory gastroesophageal reflux disease: diagnostic tools. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2013;26:6–10.

    Google Scholar 

  11. Andolfi C, Bonavina L, Kavitt RT, Konda VJ, Asti E, Patti MG. Su1151 importance of esophageal manometry and pH monitoring in the evaluation of patients with “Refractory GERD”. A multicenter study. Gastroenterology. 2016;150(4):S1205.

    Article  Google Scholar 

  12. Richter JE. How to manage refractory GERD. Nat Clin Pract Gastroenterol Hepatol. 2007;4(12):658–64.

    Article  PubMed  Google Scholar 

  13. Pyun J, Choi D, Lee L, Yoo K, Shim J. Achalasia previously diagnosed as gastroesophageal reflux. Pediatr Gastroenterol Hepatol Nutr. 2015;18(1):55–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Abdel Jalil AA, Castell DO. Ineffective Esophageal Motility (IEM): the old-new frontier in esophagology. Curr Gastroenterol Rep. 2015;18:1–7.

    Article  Google Scholar 

  15. Ribolsi M, Balestrieri P, Emerenziani S, Guarino MPL, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109(1):46–51. Nature Publishing Group

    Article  CAS  PubMed  Google Scholar 

  16. Simic AP, Skrobic OM, Gurski RR, Sljukic VM, Ivanovic NR, Pesko PM. Can different subsets of ineffective esophageal motility influence the outcome of nissen fundoplication? J Gastrointest Surg. 2014;18:1723–9.

    Article  PubMed  Google Scholar 

  17. Andolfi C, Vigneswaran Y, Kavitt RT, Herbella FA, Patti MG. Laparoscopic antireflux surgery: importance of patient’s selection and preoperative workup. J Laparoendosc Adv Surg Tech. 2016;27(2):101–5. doi:10.1089/lap.2016.0322.

    Article  Google Scholar 

  18. Mello MD, Shriver a R, Li Y, Patel a, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016;28:292–8.

    Article  CAS  PubMed  Google Scholar 

  19. Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, et al. Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry. Neurogastroenterol Motil. 2016;28:1890–901.

    Article  CAS  PubMed  Google Scholar 

  20. Wang YT, Tai LF, Yazaki E, Jafari J, Sweis R, Tucker E, et al. Investigation of dysphagia after antireflux surgery by high-resolution manometry: impact of multiple water swallows and a solid test meal on diagnosis, management, and clinical outcome. Clin Gastroenterol Hepatol. 2015;13(9):1575–83. Elsevier, Inc

    Article  PubMed  Google Scholar 

  21. Mittal R, Holloway R, Penagini R, Blackshaw L, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109(2):601–10.

    Article  CAS  PubMed  Google Scholar 

  22. Omari T, Benninga M, Sansom L, Butler R, Dent J, Davidson G. Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal disease. J Pediatr. 2006;149:468–74.

    Article  CAS  PubMed  Google Scholar 

  23. Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(3):647–55.

    Article  CAS  PubMed  Google Scholar 

  24. Pandolfino JE, Zhang QG, Ghosh SK, Han A, Boniquit C, Kahrilas PJ. Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry. Gastroenterology. 2006;131:1725–33.

    Article  PubMed  Google Scholar 

  25. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006 Mar;130(3):639–49.

    Article  PubMed  Google Scholar 

  26. Del Grande LM, Herbella F a M, Bigatao AM, Abrao H, Jardim JR, Patti MG. Pathophysiology of gastroesophageal reflux in patients with chronic pulmonary obstructive disease is linked to an increased transdiaphragmatic pressure gradient and not to a defective esophagogastric barrier. J Gastrointest Surg. 2016;20:104–10.

    Article  PubMed  Google Scholar 

  27. Roman S, Zerbib F, Belhocine K, Bruley Des Varannes S, Mion F. High resolution manometry to detect transient lower oesophageal sphincter relaxations: Diagnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria. Aliment Pharmacol Ther. 2011;34:384–93.

    Article  CAS  PubMed  Google Scholar 

  28. Kwiatek MA, Pandolfino JE, Kahrilas PJ. 3D-high resolution manometry of the esophagogastric junction. Neurogastroenterol Motil. 2011 Nov;23(11):e461–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Nicodème F, Pandolfino JE, Lin Z, Xiao Y, Escobar G, Kahrilas PJ. Adding a radial dimension to the assessment of esophagogastric junction relaxation: validation studies of the 3D-eSleeve. Am J Physiol Gastrointest Liver Physiol. 2012;303(3):G275–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ. High-resolution manometry of the EGJ: An analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102:1056–63.

    Article  PubMed  Google Scholar 

  31. E Souza MÂ, Nobre RA, Bezerra PC, Dos Santos AA, Sifrim D. Anatomical and functional deficiencies of the crural diaphragm in patients with esophagitis. Neurogastroenterol Motil. 2016;29:e12899.

    Article  Google Scholar 

  32. Weijenborg PW, van Hoeij FB, Smout a JPM, Bredenoord a J. Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil. 2015;27:293–9.

    Article  CAS  PubMed  Google Scholar 

  33. Tolone S, De Bortoli N, Marabotto E, de Cassan C, Bodini G, Roman S, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;27:1423–31.

    Article  CAS  PubMed  Google Scholar 

  34. Hoshino M, Srinivasan A, Mittal SK. High-resolution manometry patterns of lower esophageal sphincter complex in symptomatic post-fundoplication patients. J Gastrointest Surg. 2012;16:705–14.

    Article  PubMed  Google Scholar 

  35. Yamamoto SR, Akimoto S, Hoshino M, Mittal SK. High-resolution manometry findings in symptomatic post-Nissen fundoplication patients with normal endoscopic configuration. Dis Esophagus. 2015;29:967–70.

    Article  PubMed  Google Scholar 

  36. Jasper D, Freitas-Queiroz N, Hollenstein M, Misselwitz B, Layer P, Navarro-Rodriguez T, et al. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil. 2016;29:e12925.

    Article  Google Scholar 

  37. Gor P, Li Y, Munigala S, Patel a B a, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2015;29:820–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wang D, Patel a, Mello M, Shriver a, Gyawali CP. Esophagogastric junction contractile integral (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention. Neurogastroenterol Motil. 2016;28:639–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Nicodeme F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: Normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26(3):353–60.

    Article  CAS  PubMed  Google Scholar 

  40. Dell’Acqua-Cassao B, Mardiros-Herbella FA, Farah JF, Bonadiman A, Silva LC, Patti MG. Outcomes of laparoscopic Nissen fundoplication in patients with manometric patterns of esophageal motility disorders. Am Surg. 2013;79:361–5.

    PubMed  Google Scholar 

  41. Ribeiro M, Tercioti-júnior V, Souza-neto JC, Lopes LR, Morais DJ, Andreollo NA. Identification of preoperative risk factors for persistent postoperative dysphagia after laparoscopic antireflux surgery. Arq Bras Cir Dig. 2013;26(3):165–9.

    Article  PubMed  Google Scholar 

  42. Marjoux S, Roman S, Juget-Pietu F, Robert M, Poncet G, Boulez J, et al. Impaired postoperative EGJ relaxation as a determinant of post laparoscopic fundoplication dysphagia: a study with high-resolution manometry before and after surgery. Surg Endosc Other Interv Tech. 2012;26:3642–9.

    Article  Google Scholar 

  43. Myers JC, Nguyen NQ, Jamieson GG, Van’t Hek JE, Ching K, Holloway RH, et al. Susceptibility to dysphagia after fundoplication revealed by novel automated impedance manometry analysis. Neurogastroenterol Motil. 2012;24:812–e393.

    Article  CAS  PubMed  Google Scholar 

  44. Loots C, van Herwaarden MY, Benninga MA, VanderZee DC, van Wijk MP, Omari TI. Gastroesophageal reflux, esophageal function, gastric emptying, and the relationship to dysphagia before and after antireflux surgery in children. J Pediatr. 2013;162(3):566–73.e2. Mosby, Inc.

    Article  PubMed  Google Scholar 

  45. Stoikes N, Drapekin J, Kushnir V, Shaker A, Brunt LM, Gyawali CP. The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery. Surg Endosc. 2012;26(12):3401–7.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Rosen R, Rodriguez L, Nurko S. Pediatric rumination subtypes: a study using high-resolution esophageal manometry with impedance. Neurogastroenterol Motil. 2016;29:e12998.

    Article  Google Scholar 

  47. Singendonk MMJ, Oors JM, Bredenoord AJ, Omari TI, van der Pol RJ, Smits MJ, et al. Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry. Neurogastroenterol Motil. 2017;29:e12996.

    Article  Google Scholar 

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Authors and Affiliations

  1. Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, South Australia

    Taher Omari

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  1. Taher Omari
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Correspondence to Taher Omari .

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  1. Universitair Ziekenhuis Brussel, Kidz Health Castle, Brussels, Belgium

    Yvan Vandenplas

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Omari, T. (2017). Manometry. In: Vandenplas, Y. (eds) Gastroesophageal Reflux in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-60678-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-60678-1_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60677-4

  • Online ISBN: 978-3-319-60678-1

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