Ineffective esophageal motility: Characterization and outcomes across pediatric neurogastroenterology and motility centers in the United States.

Autor: Davis TA; Division of Pediatric Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA., Rogers BD; Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.; Division of Gastroenterology, University of Louisville School of Medicine, Louisville, Kentucky, USA., Llanos-Chea A; Division of Pediatric Gastroenterology, UT Southwestern Medical Center, Dallas, Texas, USA., Krasaelap A; Division of Pediatric Gastroenterology, Children's Mercy, Kansas City, Missouri, USA., Banks D; Division of Pediatric Gastroenterology, Yale School of Medicine, New Haven, Connecticut, USA., Ambartsumyan L; Division of Pediatric Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA., Sanchez RE; Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA., Yacob D; Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA., Baker C; Division of Pediatric Gastroenterology, Connecticut Children's Medical Center, Hartford, Connecticut, USA., Rey AP; Division of Pediatric Gastroenterology, Universidad El Bosque, Bogotá, Colombia., Desai C; Division of Pediatric Gastroenterology, Children's Mercy, Kansas City, Missouri, USA., Rottier A; Division of Gastroenterology, University of Louisville School of Medicine, Louisville, Kentucky, USA., Jayaraman M; Division of Pediatric Gastroenterology, Saint Louis University School of Medicine, St. Louis, Missouri, USA., Khorrami C; Division of Pediatric Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA., Dorfman L; Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., El-Chammas K; Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Mansi S; Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Chiou E; Division of Pediatric Gastroenterology, Texas Children's Hospital, Houston, Texas, USA., Chumpitazi BP; Division of Pediatric Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA., Balakrishnan K; Division of Pediatric Gastroenterology, Texas Children's Hospital, Houston, Texas, USA., Puri NB; Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA., Rodriguez L; Division of Pediatric Gastroenterology, Yale School of Medicine, New Haven, Connecticut, USA., Garza JM; Division of Pediatric Gastroenterology, Neurogastroenterology and Motility Program at Children's Healthcare of Atlanta & GI Care for Kids, Atlanta, Georgia, USA., Saps M; Division of Pediatric Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida, USA., Gyawali CP; Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA., Patel D; Division of Pediatric Gastroenterology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric gastroenterology and nutrition [J Pediatr Gastroenterol Nutr] 2024 Sep; Vol. 79 (3), pp. 541-549. Date of Electronic Publication: 2024 Jul 16.
DOI: 10.1002/jpn3.12324
Abstrakt: Objectives: Ineffective esophageal motility (IEM) on high-resolution manometry (HRM) is not consistently associated with specific clinical syndromes or outcomes. We evaluated the prevalence, clinical features, management, and outcomes of pediatric IEM patients across the United States.
Methods: Clinical and manometric characteristics of children undergoing esophageal HRM during 2021-2022 were collected from 12 pediatric motility centers. Clinical presentation, test results, management strategies, and outcomes were compared between children with IEM and normal HRM.
Results: Of 236 children (median age 15 years, 63.6% female, 79.2% Caucasian), 62 (23.6%) patients had IEM, and 174 (73.7%) patients had normal HRM, with similar demographics, medical history, clinical presentation, and median symptom duration. Reflux monitoring was performed more often for IEM patients (25.8% vs. 8.6%, p = 0.002), but other adjunctive testing was similar. Among 101 patients with follow-up, symptomatic cohorts declined in both groups in relation to the initial presentation (p > 0.107 for each comparison) with management targeting symptoms, particularly acid suppression. Though prokinetics were used more often and behavioral therapy less often in IEM (p ≤ 0.015 for each comparison), symptom outcomes were similar between IEM and normal HRM. Despite a higher proportion with residual dysphagia on follow-up in IEM (64.0% vs. 39.1%, p = 0.043), an alternate mechanism for dysphagia was identified more often in IEM (68.8%) compared to normal HRM (27.8%, p = 0.017).
Conclusions: IEM is a descriptive manometric pattern rather than a clinical diagnosis requiring specific intervention in children. Management based on clinical presentation provides consistent symptom outcomes.
(© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)
Databáze: MEDLINE
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