Marine Juzaud1, Marie-Dominique Lamblin2,3, Alexandre Fabre1,4, Marine Alessandrini5, Karine Baumstarck5, Camille Bazin6, Clothilde Esteve7, Nolwenn Laborde8,9, Lindsay Osei10, Laurent Michaud3, Frederic Gottrand3, Veronique Vitton6. 1. Service de pédiatrie multidisciplinaire, La Timone Children's Hospital, Marseille. 2. Clinical Neurophysiology Department, Lille University Hospital. 3. Pediatric Gastroenterology Department, Hepatology and Nutrition, Reference Center for Rare Esophageal Diseases, CHU Lille, University Lille, Lille. 4. Aix Marseille Université, INSERM, MMG. 5. EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University. 6. Department of Gastroenterology, North Hospital, Assistance Publique - Hôpitaux de Marseille. 7. INSERM U1251 MMG Marseille Medical Genetics Aix-Marseille Université, Marseille. 8. Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse. 9. Université de Toulouse, UPS, Toulouse, France. 10. Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, French Guiana.
Abstract
OBJECTIVES: High-resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. However, clinical signs associated with these disorders are nonspecific, and it is difficult to correlate clinical signs with HRM data. The main objective of our study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of each clinical sign, as well as their sensitivity and specificity in the diagnosis of esophageal motility disorders. METHODS: This is a bicentric retrospective cohort study based on HRM data collected between May 2012 and May 2016. The studied symptoms were weight loss, feeding difficulties, swallowing disorders, dysphagia, food blockages, vomiting, gastroesophageal reflux disease (GERD), belching, and respiratory symptoms. HRM data were analyzed according to the Chicago Classification (3.0). RESULTS: In total, 271 HRM data were analyzed, of which 90.4% showed abnormal results. HRM was well tolerated in 91% of the cases. The most common esophageal motility disorder was ineffective esophageal motility (38%). Weight loss was significantly associated (P = 0.003) with an abnormal HRM with a 96% PPV. CONCLUSIONS: With nonspecific clinical signs suggesting an esophageal motility disorder, weight loss was a predictive sign of abnormal HRM results. HRM was well tolerated in pediatric patients, and ineffective esophageal motility appears to be the most frequent motility disorder in our cohort, as already observed in adult patient studies.
OBJECTIVES: High-resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. However, clinical signs associated with these disorders are nonspecific, and it is difficult to correlate clinical signs with HRM data. The main objective of our study was to assess the positive predictive value (PPV) and negative predictive value (NPV) of each clinical sign, as well as their sensitivity and specificity in the diagnosis of esophageal motility disorders. METHODS: This is a bicentric retrospective cohort study based on HRM data collected between May 2012 and May 2016. The studied symptoms were weight loss, feeding difficulties, swallowing disorders, dysphagia, food blockages, vomiting, gastroesophageal reflux disease (GERD), belching, and respiratory symptoms. HRM data were analyzed according to the Chicago Classification (3.0). RESULTS: In total, 271 HRM data were analyzed, of which 90.4% showed abnormal results. HRM was well tolerated in 91% of the cases. The most common esophageal motility disorder was ineffective esophageal motility (38%). Weight loss was significantly associated (P = 0.003) with an abnormal HRM with a 96% PPV. CONCLUSIONS: With nonspecific clinical signs suggesting an esophageal motility disorder, weight loss was a predictive sign of abnormal HRM results. HRM was well tolerated in pediatric patients, and ineffective esophageal motility appears to be the most frequent motility disorder in our cohort, as already observed in adult patient studies.
Authors: Anna Maria Caruso; Mario Milazzo; Vincenzo Tulone; Carlo Acierno; Vincenza Girgenti; Salvatore Amoroso; Denisia Bommarito; Valeria Calcaterra; Gloria Pelizzo Journal: Children (Basel) Date: 2020-11-07