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Correlation Between Clinical Signs and High-resolution Manometry Data in Children

Juzaud, Marine*; Lamblin, Marie-Dominique†,‡; Fabre, Alexandre*,§; Alessandrini, Marine; Baumstarck, Karine; Bazin, Camille||; Esteve, Clothilde**; Laborde, Nolwenn††,‡‡; Osei, Lindsay§§; Michaud, Laurent; Gottrand, Frederic; Vitton, Veronique||

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 642–647
doi: 10.1097/MPG.0000000000002232
Original Articles: Gastroenterology

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.

*Service de pédiatrie multidisciplinaire, La Timone Children's Hospital, Marseille

Clinical Neurophysiology Department, Lille University Hospital

Pediatric Gastroenterology Department, Hepatology and Nutrition, Reference Center for Rare Esophageal Diseases, CHU Lille, University Lille, Lille

§Aix Marseille Université, INSERM, MMG

EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University

||Department of Gastroenterology, North Hospital, Assistance Publique – Hôpitaux de Marseille

**INSERM U1251 MMG Marseille Medical Genetics Aix-Marseille Université, Marseille

††Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse

‡‡Université de Toulouse, UPS, Toulouse, France

§§Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, French Guiana.

Address correspondence and reprint requests to Marine Juzaud, MD, MS, Service de pédiatrie multidisciplinaire, CHU La Timone, APHM, 264 Rue Saint Pierre, 13005 Marseille 05, Provence-Alpes-Côte d’Azur, France (e-mail:

Received 23 March, 2017

Accepted 3 December, 2018

The authors report no conflicts of interest.

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© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,