Research found many young children suffered from esophageal dysmotility per Chicago classification, despite being diagnosed with normal motility, Karlo Kovacic, MD, said during his abstract presentation at the Digestive Disease Week (DDW) 2023 in Chicago.

Dr Kovacic is an assistant professor and pediatric gastroenterologist with the Medical College of Wisconsin in Milwaukee, Wisconsin.

Children with suspected esophageal motility disorders are frequently assessed by high resolution esophageal manometry (HREM). “Children undergoing HREM are currently diagnosed according to the adult diagnostic metrics, modeled and summarized in the latest version of the Chicago Classification (CC version 4.0),” Dr Kovacic explained during the pediatric functional and motility session.

The team compared esophageal motility metrics of 41 children without dysphagia and with normal esophageal biopsies who underwent endoscopy for other reasons to 41 other children with dysphagia who had normal esophageal motility. All the pediatric participants underwent placement of 8fr HREM catheter, either awake or under anesthesia, and were given more than 10 minutes to accommodate the upper esophageal sphincter.

They compared proximal esophageal contractile integral (PCI), distal esophageal contractile integral (DCI), 4-sec integrated relaxation pressure of the lower esophageal sphincter (IRP) and length of transition zone gap (TZ).

The results for DCI between the two groups were similar, Dr Kovacic said. The median DCI for the asymptomatic cohort was 1475 mmHg-s-cm and for the symptomatic cohort was 1095 mmHg-s-cm. The median TZ was 0.07 cm for the asymptomatic cohort and 0.59 cm for the symptomatic cohort.

The results demonstrated that children with dysmotility could very easily be misdiagnosed with normal motility, Dr Kovacic explained.

Data on pediatric HREM is insufficient, he said. Also, age-appropriate developmental changes associated with esophageal peristalsis are being omitted. “Owing to these factors, there is a growing concern that children with esophageal motility disorders are being misdiagnosed,” Dr Kovacic said. “There is an urgent need to accentuate pediatric diagnostic norms.”

—Priyam Vora

Reference:
Kovacic K. Presentation #149: Substantial number of children with esophageal dysmotility are erroneously given diagnosis of normal motility per Chicago classification. Digestive Disease Week 2023. Chicago, Illinois.