Journal of Pediatric Gastroenterology and Nutrition Impact Factor & Information

Publisher: North American Society for Pediatric Gastroenterology and Nutrition; European Society for Paediatric Gastroenterology and Nutrition; North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; European Society for Pediatric Gastroenterology, Hepatology and Nutrition, Lippincott, Williams & Wilkins

Journal description

In addition to providing up-to-date information, the Journal of Pediatric Gastroenterology and Nutrition has been developed with the intention of promoting and enhancing communication throughout the gastroenterology community.

Current impact factor: 2.63

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 2.625
2013 Impact Factor 2.873
2012 Impact Factor 2.196
2011 Impact Factor 2.298
2010 Impact Factor 2.18
2009 Impact Factor 2.183
2008 Impact Factor 2.132
2007 Impact Factor 2.102
2006 Impact Factor 2.067
2005 Impact Factor 2.077
2004 Impact Factor 1.764
2003 Impact Factor 1.402
2002 Impact Factor 2.078
2001 Impact Factor 2.077
2000 Impact Factor 1.58
1999 Impact Factor 1.486
1998 Impact Factor 1.319
1997 Impact Factor 1.294
1996 Impact Factor 1.523
1995 Impact Factor 1.243
1994 Impact Factor 1.082
1993 Impact Factor 0.925
1992 Impact Factor 0.893

Impact factor over time

Impact factor

Additional details

5-year impact 2.76
Cited half-life 7.00
Immediacy index 0.64
Eigenfactor 0.02
Article influence 0.80
Website Journal of Pediatric Gastroenterology and Nutrition website
Other titles Journal of pediatric gastroenterology and nutrition, JPGN, J pediatr gastroenterol nutr
ISSN 0277-2116
OCLC 7520467
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Lippincott, Williams & Wilkins

  • Pre-print
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  • Post-print
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  • Restrictions
    • 12 months embargo
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    • Publisher's version/PDF cannot be used
    • Must include statement that it is not the final published version
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    • Set statement to accompany deposit
    • Must link to publisher version
    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
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Publications in this journal

  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):516. DOI:10.1097/01.mpg.0000472221.01669.f9
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):515-516. DOI:10.1097/01.mpg.0000472219.55927.d2
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    ABSTRACT: Objectives: This study aimed to investigate histologic features of children with RAP undergoing upper gastrointestinal endoscopy, after exclusion of common organic disease. Methods: Children referred for endoscopy were prospectively enrolled at a single tertiary center between 2008 and 2010, after obtaining informed consent. Cases were defined as children with clinical diagnosis of RAP, as opposed to controls with suspicion of organic disease. Gastric and duodenal biopsies were analysed by pathologists blinded to indication. Demographic and clinical variables, H. pylori infection, biochemical, endoscopic and pathologic results were compared between cases and controls. Results: A total of 101 children were included after exclusion of villous enteropathy (n = 6) and parasitic, rotaviral or salmonella enteritis (n = 14), resulting in 72 cases and 29 controls. There were no significant differences in demographics, clinical symptoms, H. pylori infection and endoscopic findings between cases and controls. Duodenal eosinophil counts per 5 HPF were significantly increased in cases vs. controls (median (IQR) 86 (62-114) vs. 49 (31-88); p < 0.001) and did not differ regarding age, gender and H. pylori. Intraepithelial lymphocytes per 100 enterocytes were similar in cases vs. controls (19 (15-25) vs. 18 (14-23); p = 0.89) with ≥ 25 in 25% of cases. Duodenal eosinophilia was equally observed in H. pylori negative cases (n = 50) vs. controls (n = 19) (87 (61-119) vs. 53 (36-95); p = 0.01), as well as positive cases (n = 21) vs. controls (n = 10) (85 (55-105) vs. 42 (18-65); p = 0.03). Logistic regression yielded an adjusted odds ratio of 1.23 (95% CI 1.08-1.40) for duodenal eosinophilia in RAP. Conclusions: Children with a clinical diagnosis of RAP have marked duodenal eosinophilia, independent of H. pylori infection, suggesting the role of unknown infectious or allergic triggers in the pathogenesis of functional gastrointestinal disorders in childhood. Further research is needed on the diagnostic and therapeutic benefits of targeting duodenal eosinophilia.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):522-523. DOI:10.1097/01.mpg.0000472235.37108.eb
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    ABSTRACT: Background: Abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are a common public health problem in children. The precise aetiology of AP-FGIDs is far from clear. Psychological stress and all forms of child abuse are known predisposing factors to develop AP-FGIDs. The main objective of this study is to study the association between adverse life events (ALEs) and development of AP-FGIDs. Methods: A cross sectional, school based study was conducted in Gampaha district of Sri Lanka. All children aged 13-18 years were recruited from four randomly selected semi-urban schools in the district after obtaining consent from parents, school administration and children themselves. A translated and validated, self-administered questionnaire consisting of four parts was used for data collection. Part I was the Rome III questionnaire for functional gastrointestinal disorders, self-report form for children above 10 years. Part II was a questionnaire on exposure to adverse life events. Part III was the Sinhala (the native language) version of the PedsQL, Pediatric Quality of Life Inventory 4.0 (Generic Core Scales). Part IV was the Child Somatization Inventory. The questionnaire was administered under examination setting to ensure confidentiality and privacy. Research assistant were present during filling the questionnaire for provide assistance and verifications. AP-FGIDs were defined using the Rome III criteria. Results: A total of 1792 children were included in the analysis (males 975 [54.4%], mean age 14.4 years, SD 1.3 years years). Out of them, 305 (17.0%) had AP-FGIDs. ALEs that showed a significant association with AP-FGIDs include, parental substance abuse (25.1% vs. 16.0% in controls, p = 0.015) and domestic violence (28.5% vs. 16.1%, p = 0.02). Children with AP-FGIDs exposed to ALEs have a higher somatization index compared to children not exposed to ALEs (16.9 vs. 13.4, p = 0.003), and a lower overall health-related quality of life (HRQoL) score (81.8 vs. 85.1, p = 0.02). The scores they obtained for psycho-social (86.4 vs. 92.4, p < 0.0001) and emotional (72.5 vs. 77.7, p = 0.03) domains of the HRQoL were also lower than that of children with no such experiences. Conclusions: Exposure to ALEs predispose children to develop AP-FGIDs. Experience of childhood ALEs deleteriously affects the HRQoL and somatization of children with AP-FGIDs.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):517-518. DOI:10.1097/01.mpg.0000472224.86421.3d
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    ABSTRACT: Introduction: The fatigue rate index (FRI) is a parameter in anorectal manometry (ARM) to assess sustained voluntary contraction, considering the squeeze pressure and fatigability of the external anal sphincter. It is used in adults to detect fecal incontinence even in patients who present normal squeeze pressures. The FRI in adult patients with functional constipation is similar to controls.The aim of this preliminary study was to evaluate the feasibility and values of FRI in children with retentive fecal incontinence secondary to functional constipation. Methods: This retrospective study evaluated 105 ARM performed from Jan 2014 to Apr 2015. 42 patients were selected (were able to perform a voluntary contraction and had no co-morbidities other than functional constipation). 14 of those (33,3%) collaborated in sustaining contraction for 40 seconds (s), allowing the evaluation of the FRI. Patients with retentive fecal incontinence secondary to functional constipation (n = 7, aged 6 to 13 years, 6 boys) were our interest group. Patients with functional constipation without fecal incontinence (n = 7, aged 6 to 13 years, 4 boys) were considered a reference group. The ARM were performed with a radial eight-channel perfusion catheter (Dynamed™, São Paulo, Brazil) and the FRI was calculated (Proctomaster 6.4) in the first 20 s and overall 40 s of sustained voluntary contraction. Results: In the first 20 s of contraction, the fecal incontinence group showed a significantly higher mean FRI (2.48 ± 1.39 min) compared to the reference group (1.13 ± 0.72 min, p = 0.042), which was not observed in the 40 s due to less uniform contraction. The anal resting pressure was higher in fecal incontinence group (76.83 mmHg) than in the reference group (54.13 mmHg), but the statistical study did not reach significance (p = 0.051). Discussion: The mean FRI obtained in this study is lower than the reported in constipated adults (2,8 min).We hypothesized that the higher FRI found in children with retentive fecal incontinence may be associated with retention behavior in cases of severe constipation and to higher anal resting pressure in patients with retentive incontinence. Conclusions: FRI may be feasible in older children, its reference value may be lower than in adults and it is higher among patients with retentive incontinence.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):525-526. DOI:10.1097/01.mpg.0000472241.75226.21
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):509. DOI:10.1097/MPG.0000000000000923
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    ABSTRACT: Introduction: Dysphagia, feeding difficulties and gastro-oesophageal reflux (GORD) are common complaints in neurologically impaired children. Motor pattern generators localised in the brain stem and CNS reflexes play a key role on controlling oesophageal peristalsis and lower oesophageal sphincter activity. Thus, it is not surprising that brain abnormalities may result in significant oesophageal motor dysfunction. In this prospective study we evaluated the differences in multichannel intraluminal impedance-pH monitoring (MII-pH monitoring) pattern between children with cerebral palsy (CP) and 2 groups of neurologically normal children with normal and abnormal MII-pH monitoring. We mainly focused our attention on oesophageal baseline impedance (BI), which has been proposed as useful parameter in predicting GORD severity. Methods: Twenty children with CP and 40 neurologically normal children with suspected GORD underwent MII-pH impedance. Classical MII-pH impedance parameters as well as BI values in both proximal and distal oesophagus were analysed. MII-pH monitoring was considered abnormal if acid exposure time (AET) was >5% and/or SAP was >95%. Results: Nine CP children had a diagnosis of GORD. Of neurologically normal children, 20 had an abnormal (GR-A) and 20 a normal MII-pH monitoring (GR-B). A significant difference in the proportion of children with abnormal AET was found between CP and GR-A (9/20 vs 17/20; p < 0.05). GR-A showed a significantly greater percentage of AET (15.97 [6.4-34.9]) than both CP (8.21 [0-31.9], p < 0.05) and GR-B (1.4, [0-4.5], p < 0.0001), whereas between the latter groups CP showed a greater AET (p < 0.05). Proximal BI values were significantly lower in CP (1759 [691-3133]Ω) than GR-A (2396 [1080-3850]Ω, p < 0.05) and GR-B (3385 [2249-4817]Ω, p < 0.0001). No difference in distal BI was found between in CP (1106 [279-3098]Ω) and GR-A (1152 [246-2526]Ω), while was lower in CP than in GR-B (2965 [1986-3984]Ω, p < 0.001). Considering all patients as a whole group, an inverse correlation was found between distal BI and AET (r-0.66; p < 0.001), whereas within groups an inverse correlation was only confirmed in GR-A pts (r-0.67; p < 0.001). Conclusions: Although an abnormal pH-impedance monitoring was detected in almost half of children with CP, no correlation was found between the AET and BI values, suggesting that the latter cannot be used as predictor of reflux severity in this group of patients. The presence of low impedance values in both proximal and distal oesophagus in children with CP supports the view that in neurologically impaired children BI mainly reflects oesophageal motor abnormalities, which have been previously reported.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):519-520. DOI:10.1097/01.mpg.0000472228.16916.62
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    ABSTRACT: Introduction: Some patients with myelomeningocele need bladder augmentation (augmentation cystoplasty). The aim of this study was to evaluate the relationship between the bladder augmentation and the rectoanal inhibitory reflex (RAIR) modulation in patients with myelomeningocele. The modulation of the anorectal inhibitory reflex in accord the use of oxybutynin chloride was also evaluated. Methods: It is a cross-sectional and comparative study. We studied a convenience sample consisting of 24 children and adolescents with myelomeningocele aged between 4 and 18 years. Ten of these 24 patients had surgery to expand the bladder. Anorectal manometry of perfusion were performed with 8-channel radial catheter (Dynamed®) in latex free protocol. The evaluation of the (RAIR) modulation was determined by inflating the balloon with 20 mL of air in rectal. The RAIR modulation was determined by duration (seconds) and amplitude (% relaxation) of RAIR. Results: RAIR was present in all the patients. The duration of the RAIR (seconds) with 20 mL and 40 mL was similar in the both groups, with or without bladder augmentation (27.11 ± 11.95; 27.37 ± 9.29; p = 0.953 and 30.32 ± 7.30; 32.08 ± 10.13, p = 0.653).The RAIR amplitude with 20 mL and 40 mL was higher in the patients with bladder augmentation than in patients without bladder augmentation (63.87 ± 24.58; 82.31 ± 15.94, p = 0.036 and 68.06 ± 14.80;88.93 ± 16.31, p = 0.004). The patients who used oxybutynin chloride presented higher amplitude (% relaxation) in relation those did not used this drug, with 20 mL (80.91 ± 15.37 and 65.21 ± 25.73; p = 0.074) and 40 mL (85.78 ± 15.96 and 73.05 ± 19.29; p = 0.084), however, the statistic evaluation did not reach significance. Conclusions: The RAIR modulation is different between patients with and without bladder augmentation. The use of oxybutynin chloride also appears to interfere in the RAIR, increasing its amplitude.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):512-513. DOI:10.1097/01.mpg.0000472213.48303.db
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):510-511. DOI:10.1097/01.mpg.0000472209.38894.78
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    ABSTRACT: Background: Gaestroesophageal reflux (GER) occurs commonly in infants especially preterm infants. Current anti-reflux medication has shown limited therapeutic benefits for this age group. Our study aims to evaluate the efficacy of extensively hydrolyzed formula feed (EHFF) compared to standard infant formula (SF) on GER episodes in preterm infants using Multichannel intraluminal impedance and pH monitoring (MII-pH). Methods: This is a prospective crossover trial involving preterm infants >29 weeks corrected gestation age with symptoms of GER. All patiets were recruited from a single tertiary neonatal unit in Singapore. MII-pH was performed over 48 hours. For the first 24 hours the infants were either fed on standardized infant formula (SF) or Expressed Breast Milk (EBM) depending on maternal choice. For the second 24 hours their feeds were changed to EHFF. All infants were on orogastric/nasagastric tube feeding and were given 2 to 3 hourly bolus feeding throughout the study period. Results: 23 infants completed the study:14males: 9 females. Mean weight 2971 g (SD +1569 g). None of the patients were on any anti-reflux medications (apart from one). Type of feeds during first 24 hours were EBM 8/23(35%), SF 5/23(22%) or mixed feeding 10/23(43%). GER symptoms were: desaturations16/23(70%), cough 8/23(35%), arching7/23 (30%), vomit 3/23(13%), crying2/23(8%) and apnoea1/23 (4%). The median total GER episodes (detected by pH and MII) was significantly lower during the EHFF period compared to SF/EBM period 42(21-71) vs 68(32-104) p < 0.001. The median acidic reflux episodes detected by pH was also significantly lower in EHFF vs SF/EBM period 8(4-24) vs 23(3-58) p < 0.005. Total number of refluxes detected by MII showed a significant reduction for EHFF compared to SF/EBM: 17(11-56) vs 46(20-65) p < 0.015. There was no difference in reflux index, MII bolus exposure indexes, and number of long lasting episodes (>5 min) between the 2 groups. There were no significant difference in the number of symptoms recorded between the two study period. Conclusions: Our data suggest that the number of gastroesophageal reflux was significantly lower in preterm infants fed with EHFF compared to standard formula as measured by pH-MII monitoring. EHFF may potentially be an effective treatment modality for gastroesophageal reflux disease in infants with minimal side-effects. The lack of symptom reduction during EHFF despite fewer GER episodes suggests that other pathology other than GER should be considered. A larger study is required to further evaluate the efficacy and mechanism of EHFF on reduction of GER in infants.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):526. DOI:10.1097/01.mpg.0000472243.59979.4a
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    ABSTRACT: Aim: evaluate if supernatants harvested from LGG cultures protect SMC from LPS-induced myogenic damage. Methods: L. rhamnosus GG (ATCC 53103 strain) was grown in MRS medium and samples were collected from bacterial cultures in middle exponential phase,in early,in middle and late stationary phase (overnight).Supernatants were recovered,filtered and stored at -20 °C. Highly pure human SMC culture was then exposed for 24 h to highly purified LPS (1 μg/ml) of E.coli (O111:B4) in the absence and presence of the supernatants.Their effects were evaluated on LPS-induced SMC morphofunctional alterations and pro-inflammatory IL-6 production. Data are expressed as mean ± SE (p < 0.05 significant). Results: LPS induced persistent significant 20.7% ± 1.2 cell shortening and 35.2% ± 2.6 decrease in contraction of human colonic SMC. These alterations were paralleled to a 238.5% ± 82.5 increase in IL-6 production.These effects disappeared in the presence of LGG-supernatants,following a progression related to LGG growth curve phases. Supernatants collected in the middle exponential phase already significantly partially restored LPS-induced cell shortening by 43.4% ± 10.2 and IL6 increase by 47.6% ± 13.1 but had no effect on LPS-induced inhibition of contraction. Supernatants collected later, in the early and middle stationary phase, further counteract LPS-induced damage, including inhibition of contraction. Maximal protective effects were observed with supernatants of the late stationary phase where LPS-induced cell shortening was reversed by 86% ± 4.7, inhibition of contraction by 98.2% ± 1.8 and IL6 basal production by 91.3% ± 0.6. Conclusions: LGG secreted products are substances/byproducts able to directly protect human SMC from LPS-induced myogenic damage.Novel insights are then provided about the possibility that LGG-derived products could reduce the risk of progression to a post-infective motor disorder.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):509-510. DOI:10.1097/01.mpg.0000472207.54141.fa
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    ABSTRACT: Introduction: The main advantage of multichannel intraluminar impedance (MII) compared with pH monitoring is its ability to detect both acid and non-acid gastroesophageal reflux (GER) and to determine the characteristics of reflux (liquid or gas). Aim: To compare the value of pH monitoring and MII for diagnosis of GER in children who present with refractory respiratory symptoms. Materials: A prospective study that included 37 patients, aged 4.25 ± 3.15 years, using combined MII-pH monitoring was performed. Patients were referred for investigation because of suspected GER as the etiology of recurrent respiratory diseases, including recurrent obstructive bronchitis, recurrent pneumonia, laryngitis, and chronic cough. We analyzed the percentage of time during which the pH was less than 4, the numeric and percentile values of acid, weak acid, and non-acid reflux episodes, and the values of liquid and mixed reflux. Diagnostic values were determined separately for pH monitoring and MII using Fisher's exact test. Results: Reflux was detected in 31 patients. pH monitoring was positive in 20 patients (% time during which pH <4 was 17.72 ± 12.06) and negative in 17 patients (2.93% ± 1.67). Both pH and MII were positive in 19 patients: in 11 patients, MII was positive and pH was negative, and in 6 patients, both were negative. Fisher's exact test showed significant statistical difference and superiority of MII in diagnosing GER (p = 0.033). Out of 30 patients with MII-positive results, 15 had both acid and weak acid reflux episodes, 3 had only acid reflux, 8 had weak acid reflux, and 3 had non-acid reflux. Sixteen patients had mixed (liquid and gas) reflux, and 14 had both liquid and mixed reflux. Conclusions: This study suggests that significant numbers of GER include weak acid reflux that cannot be detected by pH probes alone. The weak acid reflux could be a trigger for recurrent respiratory symptoms. Combining pH with MII monitoring is a valuable diagnostic method for diagnosing GER in children.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):527. DOI:10.1097/01.mpg.0000472244.98097.fd
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):513. DOI:10.1097/01.mpg.0000472214.25432.88
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):512. DOI:10.1097/01.mpg.0000472212.40680.46
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    ABSTRACT: Aims: The role of esophageal clearance is still scarcely investigated in patients with gastroesophageal reflux disease (GERD). We aimed to assess esophageal clearance in adolescents by means of bolus clearance time (BCT) and to verify if there is any difference among subgroups of GERD patients according to endoscopic and impedance-pH monitoring findings. Methods: We revised endoscopic and impedance-pH monitoring (off-therapy) data of 28 consecutive adolescents (range 12-16 years). We evaluated acid exposure time (AET), total number of reflux episodes, baseline impedance (BI), and BCT. According to impedance-pH monitoring features, adolescents were grouped into pH/MII negative (normal AET and normal number of refluxes), and pH/MII positive (abnormal AET and/or abnormal number of refluxes). This latter were further subgrouped on the basis of abnormal/normal AET (pH+/-) and abnormal/normal number of refluxes (MII+/-). Finally, adolescents were also classified as erosive and non erosive reflux disease (ERD, NERD). Results: We observed 22 pH/MII positive adolescents (7 ERD and 15 NERD). Eight patients were further subgrouped as pH+/MII-, 6 as pH-/MII+ and 8 as pH+/MII+. BCT values (in seconds) progressively decreased from pH+/MII+, pH+/MII-, pH-/MII+ to pH-/MII- (34.5 ± 8.1 vs. 22.0 ± 7.2 vs. 16.4 ± 4.5 vs. 10.1 ± 2.1, respectively; p < 0.001), whereas BI gradually increased (1236 ± 358 vs. 1592 ± 762 vs. 1854 ± 567 vs. 3256 ± 743, respectively; p < 0.001). There was an inverse correlation between BCT and BI, and a direct correlation between BCT and AET (p < 0.0001) and ERD presence (p < 0.0001). Conclusions: BCT seems to reflects reflux severity, and it is inversely correlated to BI, a marker of mucosal integrity, supporting the role of esophageal clearance in the GERD pathophysiology.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):522. DOI:10.1097/01.mpg.0000472234.98989.09
  • Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):519. DOI:10.1097/01.mpg.0000472227.39787.b8
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    ABSTRACT: Background: Esophageal High Resolution Manometry (eHRM) is a widely available technique to evaluate dysphagia symptoms in children. In adults, the 4 second integrated relaxation pressure (IRP4 s) has been used to characterize lower esophageal sphincter function and esophageal obstruction. To date, no study has evaluated the utility of the IRP to predict achalasia in children. Aims: To determine the utility of the IRP4 s to predict achalasia in a cohort of children with achalasia. Methods: Following IRB approval, records at New York Presbyterian Hospital-Weill Cornell Medical College were reviewed for pediatric patients undergoing eHRM. Manometric studies were performed using the Manoscan Eso System (Given Imaging, USA) and solid-state catheters. Children with greater than 80% normal peristalsis and complete esophageal emptying based on barium fluoroscopy, impedance or other clinical criteria were considered control subjects. Children with greater than 20% abnormal peristalsis and evidence of esophageal obstruction by fluoroscopic, impedance or clinical criteria were considered achalasia subjects. Categorical data was evaluated using chi-squared tests. Continuous variables were compared using the Student's t-test. Receiver operator curve (ROC) analysis was used to determine the best IRP4 s cut-point to predict achalasia. Results: 16 children (9 M) were identified as controls and 12 children (8 M) identified as having achalasia. All achalasia subtypes were identified in the cohort: type 1 (n = 3), 2 (5) and 3 (1). Control children were older than achalasia children (13.9 ± 3.6y vs. 9.92 ± 5.0y, p = 0.021), but there was no difference in gender distribution. Mean esophageal length (22.7 ± 2.7 cm vs 20.6 ± 4.6 cm, p = 0.14) and basal LES pressure (23.6 ± 11.7mmHg vs 23.0 ± 12.9mmHg, p = 0.91) were similar between groups. However, the IRP4 s was significantly greater in the achalasia group vs. controls (17.9 ± 8.9 mmHg vs 7.0 ± 3.6mmHg, p = 0.0002). ROC analysis predicted an optimal IRP4 s cut-point of 12.3mmHg, (empiric AUC = 0.844, sens = 75%, spec = 93.8%, accuracy = 85.7%, PPV = 90%, NPV = 83.3%, LR(+) = 12, LR(-) = 0.27). Based on this cut-point, 3 false negative results occurred in children with achalasia type 2 based on morphologic appearance of eHRM and esophageal obstruction on fluoroscopy. The single false positive case had normal fluoroscopy and 100% peristalsis eHRM morphology. Discussion: This study suggests that an IRP4 s greater than 12.3mmHg is predictive of achalasia in children, particularly when used in conjunction with other clinical signs such as esophageal obstruction on barium fluoroscopy and abnormal peristalsis on eHRM. This finding is limited to studies performed using the Manoscan Eso platform and solid-state eHRM catheters, as adult studies suggest variation in absolute pressure measurements occur among motility platforms and catheter types. While this study reports on a large cohort of children with achalasia, this study may be limited due to its overall small sample size and difference in age ranges between groups. Conclusions: IRP4 s is a useful eHRM measure to aid in the identification of children with achalasia. Multi-center studies will provide additional support for the use of the eHRM measurements best suited to categorize esophageal outlet obstruction in children.
    Journal of Pediatric Gastroenterology and Nutrition 10/2015; 61(4):521. DOI:10.1097/01.mpg.0000472231.06614.b4