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Comments on “Diffuse Esophageal Spasm in Children Referred for Manometry”

Agarwal, Jaya; Reddy, D. Nageshwar

Journal of Pediatric Gastroenterology and Nutrition: July 2013 - Volume 57 - Issue 1 - p e8–e9
doi: 10.1097/MPG.0b013e3182920747
Letters to the Editor

Asian Institute of Gastroenterology Hyderabad, Andhra Pradesh, India

To the Editor: I read with interest the article by Rosen et al (1); however, I would like to comment on certain aspects of the study, which are questionable and not well elucidated. First is disagreement regarding the criteria used in this study for labeling a given child as having DES with “simultaneous esophageal body contractions associated with >10% of swallows” versus “>20% of swallows,” that is, a criteria used in majority of esophageal manometry literature (2,3). Hence, it may have led to false higher reporting rate of DES as 13% in this pediatric study, whereas in adult studies, it accounts for 4% to 7% of all esophageal motility disorders (3). Nevertheless, much has changed with advent of high-resolution manometry and esophageal pressure topography followed by the Chicago classification for esophageal motility disorders, wherein the term DES is replaced by distal esophageal spasm defined as “spasm with (CFV >8 cm/s) ≥20% of swallows” (4). Many of cases labeled as DES on conventional manometry were later reviewed by high-resolution manometry and found to be lower esophageal sphincter pseudorelaxation secondary to esophageal shortening, leading to erroneous diagnosis of DES instead of achalasia (5,6). Recently 2 new tools have been applied, contractile deceleration point and distal contractile latency that in EPT analysis improve the recognition of spasm (7). Moreover, ineffective esophageal motility in patients with severe eosinophilic esophagitis may mimic DES; therefore, results of esophagogastroduodenoscopy in lieu of unavailable esophageal biopsy results would have given better insight. Additionally, the statement has some disparity of the total number of patients included in the study (n = 278) and actual number (total for all subgroups is 277).

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1. Rosen JM, Lavenbarg T, Cocjin J, et al. Diffuse esophageal spasm (DES) in children referred for manometry. J Pediatr Gastroenterol Nutr 2013; 56:436–438.
2. Tutuian R, Mainie I, Agrawal A, et al. Symptom and function heterogenicity among patients with distal esophageal spasm: studies using combined impedance-manometry. Am J Gastroenterol 2006; 101:464–469.
3. Sperandio M, Tutuian R, Gideon RM, et al. Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES). Dig Dis Sci 2003; 48:1380–1384.
4. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography the Chicago classification. J Clin Gastroenterol 2008; 42:627–635.
5. Pandolfino JE, Fox MR, Bredenoord AJ, et al. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 2009; 21:796–806.
6. Roman S, Kahrilas PJ. Distal esophageal spasm. Dysphagia 2012; 27:115–123.
7. Roman S, Kahrilas PJ. Challenges in the swallowing mechanism: non-obstructivedysphagia in the era of high resolution manometry and impedance. Gastroenterol Clin North Am 2011; 40:823–835.
© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,