目的:高分辨率测压(HRM)的无效食管运动(IEM)与特定的临床综合征或结局并不一致。我们评估了患病率,临床特征,管理,以及美国儿科IEM患者的结局。
方法:从12个儿科运动中心收集了2021-2022年接受食管HRM的儿童的临床和测压特征。临床表现,测试结果,管理策略,并比较IEM儿童和正常HRM儿童的结局。
结果:在236名儿童中(中位年龄15岁,63.6%女性,79.2%高加索人),62例(23.6%)患者有IEM,174例(73.7%)患者的人力资源管理正常,具有相似的人口统计学,病史,临床表现,和中位症状持续时间。对IEM患者进行反流监测的频率更高(25.8%vs.8.6%,p=0.002),但其他辅助测试相似。在101例随访患者中,两组的症状队列与初始表现有关(每个比较的p>0.107),以症状为目标的管理,特别是酸抑制。尽管在IEM中更经常使用前动力学疗法,而行为疗法则较少(每次比较p≤0.015),IEM和正常HRM的症状结局相似.尽管在IEM的随访中残余吞咽困难的比例更高(64.0%vs.39.1%,p=0.043),与正常人力资源管理(27.8%,p=0.017)。
结论:IEM是一种描述性测压模式,而不是需要对儿童进行特定干预的临床诊断。基于临床表现的管理提供一致的症状结果。
OBJECTIVE: 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.