Nonspecific esophageal motility disorders in children without gastroesophageal reflux

Background: Nonspecific esophageal motility disorders (NEMDs) have been ide ntified in up to 50% of adults with noncardiac chest pain or dysphagia. Thi s study sought to determine the incidence of NEMDs in children with upper g astrointestinal tract symptoms and to evaluate the clinical course of pedia tric patients with these manometric abnormalities. Methods: The study involved 154 children aged 4 to 18 years (mean age, 11.6 +/- 2.6 years [SE]) who had upper gastrointestinal, swallowing-related sym ptoms. The children were evaluated by 24-hour intraesophageal pH monitoring , esophageal manometry, and esophagogastroduodenoscopy. Results: Gastroesophageal reflux (GER) was diagnosed by pH study in 109 (71 %) of 154 patients, and examination of biopsy specimens demonstrated esopha gitis in 70 children with GER. Results of esophageal manometry were abnorma l in 30 (67%) of 45 children without GER. A variety of motility disorders w ere diagnosed in 17 of the patients without GER, whereas NEMDs were diagnos ed in the remaining 13 children (mean age, 10.6 +/- 2.7 years; 10 buys, 3 g irls). Patients with GER showed normal esophageal wave propagation; however , mean lower esophageal sphincter pressure was significantly lower in patie nts with GER than in children with NEMDs. The children with NEMDs exhibited a diverse array of symptoms, including esophageal food impaction in 4 of t he 13 patients. During a 36.2 +/- 4.3-month follow-up period, no correlatio n was found between therapeutic intervention and clinical course in the 13 patients with NEMDs. Symptomatic improvement occurred in 6 of 13 patients, including 3 children for whom no pharmacologic therapy was prescribed. Conclusions: These data indicate that NEMDs represent a common group of eso phageal manometric abnormalities in children with upper gastrointestinal tr act symptoms and without GER. Food impaction appears to be a relatively fre quent complication, and NEMDs should be considered in children who have thi s finding.