Project Details

Improving Diagnostic Precision for Esophageal Disorders with Pediatric-Specific Manometry Thresholds

Trevor Davis, MD

Summary

BACKGROUND: Esophageal motility disorders are diagnosed using high-resolution manometry (HRM) and categorized by the Chicago Classification (CC); however, manometric thresholds used in CC diagnoses are exclusively derived from adult data. Extrapolation of adult thresholds to children biases testing interpretation towards over-diagnosis, potentially obligating irreversible surgical myotomy or high-risk endoscopic interventions, which may lead to further negative downstream psychosocial and physically harmful sequelae. GAP: No pediatric-specific manometric thresholds exist for use with HRM and CC diagnoses. HYPOTHESIS: We hypothesize that pediatric-specific HRM thresholds will improve diagnostic specificity for esophageal motility disorders in children, and categorization based on pubertal status will further refine diagnostic accuracy. METHODS: Healthy, pre-pubescent children without esophageal symptoms will undergo high-resolution manometry to assess esophageal motor function. The measurements collected will be utilized to develop pediatric-specific manometric thresholds. RESULTS: Pending. IMPACT: Development of pediatric-specific manometric thresholds will enable the field to transition from adult thresholds that have been used over the past two decades toward precision diagnosis for pediatric esophageal motility disorders. In addition, we will be better equipped to confidently exclude motor disorders when none exist. With improved diagnostic specificity, irreversible, invasive management can be appropriately targeted, and behavioral therapy can be offered earlier for disorders of gut-brain interaction (DGBI) when manometry is normal.