Prospective evaluation of the diagnostic yield and tolerance of high-resolution manometry, pH-impedance, and pH-impedance-manometry.

OBJECTIVES

We prospectively evaluated the interpretability, diagnostic yield, and tolerance of high-resolution (impedance-) manometry, 24 h-pH-impedance and pH-MII with manometry (two catheters) in children.

METHODS

All children who underwent testing were eligible. We assessed whether the results explained the patients' symptoms (interpretability) and recorded the diagnostic yield of each test. A validated questionnaire (DISCOmfort in Research with Children [DISCO-RC]) was additionally used to measure discomfort during the procedures.

RESULTS

Forty-nine HR(I)M, 35 pH-MII, and 9 pH-MII + mano were performed in 62 children (median age: 13 [0-18] years). Nine (25%) pH-MII catheters were placed under sedation during another procedure. Seven (7.4%) tests (five h(I)M and two pH-MII) were uninterpretable. All normal tests were considered clinically helpful by the attending physician. Sixty-nine (74.2%) tests in 58 patients (93.5%) led to clinical management that would likely not have occurred without testing. DISCO-RC scores were 7.0 (1-17), 6.0 (01-19), and 14.0 [9-17] in HR(I)M, pH-MII, and pH-MII + mano, respectively. DISCO-RC scores were significantly higher in pH-MII + mano (p = 0.033 and p = 0.005) compared to HR(I)M and pH-MII respectively.

CONCLUSION

HR(I)M, pH-MII, and pH-MII + mano are interpretable and clinically useful in most children. HR(I)M and pH-MII are reasonably well tolerated, whereas adding ambulatory manometry causes more discomfort and should be reserved for cases where the diagnosis of rumination cannot be made without it.