• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권4호
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• pp.300-311
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• 2022

Purpose: Dysphagia, vomiting and feeding difficulties are common symptoms, with which children present. Esophageal function testing with high resolution manometry can help in diagnosing and treating these patients. We aim to access the clinical utility of high-resolution manometry of esophagus in symptomatic pediatric patients. Methods: A retrospective chart review was done on all symptomatic patients who underwent esophageal high-resolution manometry between 2010 and 2019 at Sydney Children's Hospital, Australia. Manometry results were categorized based on Chicago classification. Demographic data, indication of procedure, manometric findings, and details of treatment changes were obtained and analyzed. Results: There were 62 patients with median age of 10 years (9 months-18 years). The main indication for the procedure was dysphagia (56%). Thirty-two percent of patients had a co-morbid condition, with esophageal atresia accounting for 16%. The majority (77%) of patients had abnormal manometry which included, ineffective esophageal motility in 45.2%. In esophageal atresia cohort, esophageal pressurization was seen in 50%, aperistalsis in 40% and 10% with prior fundoplication had esophago-gastric junction obstruction. Patients with esophago-gastric junction obstruction or achalasia were treated by either pneumatic dilation or Heller's myotomy. Patients with ineffective esophageal motility and rumination were treated with a trial of prokinetics/dietary texture modification and diaphragmatic breathing. Conclusion: Esophageal high-resolution manometry has a role in the evaluation of symptomatic pediatric patients. The majority of our patients had abnormal results which led to change in treatments, with either medication, surgery and/or feeding modification with resultant improvement in symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권1호
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• pp.23-30
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• 2014

Manometry is a noninvasive diagnostic tool for identifying motility dysfunction of the gastrointestinal tract. Despite the great technical advances in monitoring motility, performance of the study in pediatric patients has several limitations that should be considered during the procedure and interpretation of the test results. This article reviews the clinical applications of conventional esophageal and anorectal manometries in children by describing a technique for performing the test. This review will develop the uniformity required for the methods of performance, the parameters for measurement, and interpretation of test results that could be applied in pediatric clinical practice.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권1호
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• pp.55-59
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• 2015

Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.

• Advances in pediatric surgery
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• 제20권2호
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• pp.33-37
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• 2014

Purpose: The purpose of this study was to compare the diagnostic accuracy of the non-invasive diagnostic methods and rectal suction biopsy for the detection of Hirschsprung disease (HD). Methods: We reviewed diagnostic methods and results retrospectively in patients who underwent anorectal manometry, barium enema and rectal suction biopsy for the diagnosis of HD at Asan Medical Center from January 2000 to December 2012. Results: There were 97 patients (59 neonates and 38 infants) in the study period. The overall accuracy of anorectal manometry for the diagnosis of HD was 71.1% and its sensitivity was 51.4% (48.1% in neonate and 62.5% in infant, respectively) and its overall specificity was 82.3% (81.3% in neonate and 83.3% in infant, respectively). The Overall accuracy of barium enema was 66.0% (72.8% in neonate and 55.3% in infant, respectively) and specificity of barium enema was 53.2% (56.3% in neonate and 50.0% in infant, respectively). These results were lower than those of anorectal manometry. The overall sensitivity of barium enema was 88.6% (92.6% in neonate and 75.0% in infant, respectively) and it was higher than the sensitivity of anorectal manometry. Histological studies confirmed HD in 35 patients, in one of whom the suction biopsy showed negative finding. Conclusion: Accuracy of non-invasive methods for diagnosis of HD in our study is lower than those in previous study, so we need to improve the quality of diagnostic tools in our hospital. We conclude that the rectal suction biopsy is the most accurate test for diagnosing HD, so the biopsy to confirm the diagnosis of the HD is very important.

• Journal of Neurogastroenterology and Motility
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• 제24권4호
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• pp.570-576
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• 2018

Background/Aims Swallows with viscous or solid boluses in different body positions alter esophageal manometry patterns. Limitations of previous studies include lack of standardized viscous substrates and the need for chewing prior to swallowing solid boluses. We hypothesize that high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions improves sensitivity for detecting esophageal motility abnormalities when compared with traditional saline swallows. To establish normative values for these novel substrates, we recruited healthy volunteers and performed HRiM. Methods Standardized viscous and super-viscous substrates were prepared using "Thick-It" food thickener and a rotational viscometer. All swallows were administered in 5-mL increments in both supine and upright positions. HRiM metrics and impedance (bolus transit) were calculated. We used a paired two-tailed t test to compare all metrics by position and substrate. Results The 5-g, 7-g, and 10-g substrates measured 5000, 36 200, and 64 $700mPa{\cdot}sec$, respectively. In 18 volunteers, we observed that the integrated relaxation pressure was lower when upright than when supine for all substrates (P < 0.01). The 10-g substrate significantly increased integrated relaxation pressure when compared to saline in the supine position (P < 0.01). Substrates and positions also affected distal contractile integral, distal latency, and impedance values. Conclusions We examined HRiM values using novel standardized viscous and super-viscous substrates in healthy subjects for both supine and upright positions. We found that viscosity and position affected HRiM Chicago metrics and have potential to increase the sensitivity of esophageal manometry.

• Journal of Chest Surgery
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• 제17권2호
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• pp.280-285
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• 1984

Although it is suspected that the foreign body sensation on the pharyngoesophageal region is caused by motility disturbance of upper esophageal sphincter, its pathophysiology is not yet clear. Esophageal manometry has become an important diagnostic tool in the evaluation of esophageal motor disorders such as dysfunction of upper esophageal sphincter. Intraluminal esophageal pressures were measured by perfusion manometry in fifteen patients with foreign body sensation on the pharyngoesophageal region and in twenty six controls. In upper esophageal sphincter, mean value of resting pressure of the patients by rapid pull-through technique was 45,9\ulcorner 15.6mmHg and 80.9\ulcorner9.7mmHg in the controls. The difference between the two groups was statistically significant. The distance from nostril to sphincter, length of sphincter, and resting pressure by station pull-through technique were not significantly different. The amplitude of esophageal peristalsis in the patients was reduced significantly at the level of the upper, mid and lower esophagus. The wave duration of the patients was reduced significantly at the level the upper and mid esophagus. The speed showed no difference between two groups. Length and resting pressure of lower esophageal sphincter revealed almost same values in two groups.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권1호
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• pp.24-31
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• 2003

목 적: Hirschsprung병의 진단 시 일차적 선별검사로서 항문직장 내압검사의 유용성을 평가하고 한국 영아에서 이 검사에 대한 자료를 제공하고자 본 연구를 시행하였다. 방 법: 1995년 7월부터 2002년 5월까지 서울아산병원에 복부팽만이나 구토, 배변장애, 만성설사 등으로 내원하여 항문직장 내압검사를 시행한 61례를 대상으로 그들의 의무기록 정보를 후향적으로 분석하였다. 그 중 33례에서 대장조영술을 시행하였고 두 가지 검사에서 Hirschsprung병이 의심되었을 때 교정 수술 시 얻은 전근육 조직생검상 신경절 세포의 결여를 확인하여 진단하였다. Hirschsprung병의 진단에 대한 항문직장 내압검사와 대장조영술의 예민도, 특이도, 양성 예측치, 음성 예측치를 비교분석 하였고 정상 대조군의 항문괄약근의 길이와 직장항문 억제반사를 일으키는데 필요한 풍선의 공기량을 측정하였다. 결 과: Hirschsprung병으로 확진돤 18례를 환자군으로, 나머지 43례를 대조군으로 하여 측정한 항문직장 내압검사의 민감도, 특이도, 양성 예측도, 음성 예측도는 각각 1.00, 0.91, 0.82, 1.00이었고 대장조영술은 각각 0.93, 0.67, 0.70, 0.92이었다. 정상 대조군에 서 측정한 항문괄약근의 평균길이는 $1.68{\pm}0.67$ cm로 신장, 연령, 체중과 모두 상관 관계를 보였으며 그중 신장과 가장 유의한 상관 관계를 보였다. 또한 정상 대조군에서 직장항문 억제반사를 일으키기 위해 직장내 위치한 풍선에 주입한 공기량의 중위수는 10 mL (5~20 mL)이었고 이는 신장이나 연령, 체중과의 상관관계를 보이지 않았다. 결 론: Hirschsprung병의 진단 시 항문직장 내압검사는 일차 선별검사 방법으로 매우 유용함을 확인 할 수 있었다. 또한 정상 대조군에서 측정한 항문괄약근의 길이에 대한 자료는 향후 국내에서 영아를 대상으로 한 항문직장 내압검사에 도움이 될 것으로 생각된다.

• 대한기관식도과학회지
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• 제2권1호
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• pp.88-96
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• 1996

In recently the gastroesophageal reflux disease(GERD) has been known to induce the otolaryngologic manifestations. Pharyngeal neurosis is a disease which we could have not found the cause frequently. So we have studied the relation between the pharyngeal neurosis and the GERD among 50 patients who were diagnosed as pharyngeal neurosis after esophagogram and laryngoscopic examination. We performed esophageal manometry and 24hour double-probe pH-metry and then compared with normal control group(n=30). The results are as follows 1 Among 50 patients, 12(24%) patients were diagnosed as GERD by DeMeester scoring. 2. In esophageal manometry, the upper and lower esophageal sphincter between the patients and the control group have no significant difference(p>0.05) and 9 among 50 pateints showed abnormal peristaltic movement in esophageal body contraction. 3. In 24hour double-probe pH-metry, the esophageal probe showed that in GERD group(n= 12) the number of reflux episode, episodes greater than 5 minutes and the percentage of time

• Advances in pediatric surgery
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• 제5권2호
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• pp.103-110
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• 1999

To estimate the normal anal canal pressure in neonates, anal manometry was performed in 46 normal babies less than 6 days of age. Twenty-eight of the subjects were boys and 18 girls. All the subjects passed meconium within 24 hours after birth. Birth weights were above 2.4 kg. There were no sexual differences in birth weight, birth height, gestational age, postnatal age, or Apgar score (p<0.05). The mean manometry values were; anal sphincter length $18.6{\pm}3.9$ mm, high pressure zone (HPZ) $9.2{\pm}3.6$ mm, vector volume $2027.2{\pm}2440.7$ mmHg2cm, maximum pressure $42.3{\pm}17.4$ mmHg, and position of the maximum pressure $6.0{\pm}22.4$ mm. Only the HPZ of boys was longer than those of girls (p=0.005). In squeezing state, HPZ and the position of maximun pressure were not changed from resting state. HPZ, vector volume, and maximum pressure in boys were higher than those in girls. As the birth weight increased, the anal sphincter length (p=0.001) and the HPZ increased (p=0.047). The resting pressures of the anal canal were evaluated in three portions; /23 upper portion, $12.8{\pm}8.6$ mmHg, middle portion, $20.3{\pm}10.8$ mmHg, and lower portion, $26.1{\pm}12.9$ mmHg. These normal values may serve as guidelines for the evaluation, diagnosis and treatment of neonatal anal diseases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권4호
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• pp.257-263
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• 2018

Purpose: Studies on the physiology of the transposed stomach as an esophageal substitute in the form of a gastric pull-up or a gastric tube in children are limited. We conducted a study of motility and the pH of gastric esophageal substitutes using manometry and 24-hour pH measurements in 10 such patients. Methods: Manometry and 24 hour pH studies were performed on 10 children aged 24 to 55 months who had undergone gastric esophageal replacement. Results: Six gastric tubes (4, isoperistaltic; 2, reverse gastric tubes) and 4 gastric pull-ups were studied. Two gastric tubes and 4 gastric pull-ups were transhiatal. Four gastric tubes were retrosternal. The mean of the lowest pH at the midpoint of the substitute was 4.0 (range, 2.8-5.0) and in the stomach remaining below the diaphragm was 3.3 (range, 1.9-4.2). In both types of substitute, the difference between the peak and the nadir pH recorded in the intra-thoracic and the sub-diaphragmatic portion of the stomach was statistically significant (p<0.05), with the pH in the portion below the diaphragm being lower. The lowest pH values in the substitute and in the remnant stomach were noted mainly in the evening hours whereas the highest pH was noted mainly in the morning hours. All the cases showed a simultaneous rise in the intra-cavitatory pressure along the substitute while swallowing. Conclusion: The study suggested a normal gastric circadian rhythm in the gastric esophageal substitute. Mass contractions occurred in response to swallowing. The substitute may be able to effectively clear contents.