125 QUALITATIVE ANALYSIS OF FASTING ANTRODUODENAL MANOMETRY.

Abstract

Antroduodenal manometry has been used to determine the pathophysiology associated with signs and symptoms of motility disorders. The value of antroduodenal manometry has been limited by a paucity of data from normal children. In this study, we compared antroduodenal manometry from 95 children (mean age 4.6 y, range 2 mo-20 y, 52 male) with symptoms suggesting a motility disorder to 20 control children without upper gastrointestinal tract symptoms(mean age 7.5 y, range 2 mo-18 y, 10 male). A single investigator unaware of the patient histories visually analyzed the qualitative features of the record for the first 4 h following a 12 h preparatory fast. Phase 3 of the migrating motor complex was less frequent in patients (P < 0.05), especially in those who required total parenteral nutrition (P < 0.001), than in controls. Stationary or retrograde phase 3 migration and intervals <30 min between phase 3s were more frequent in patients than in controls (P < 0.01 and P < 0.05, respectively). Short (<3 min) or prolonged (>10 min) phase 3 duration, absence of phase 1 following phase 3, tonic pressure increases >10 mmHg for longer than 1 min during phase 3, low amplitude of phase 3 contractions in a single recording site, clustered contractions (12/min contractions for more than 30 s), and prolonged propagating contractions (propagating over 6 cm or more within 6 s, with amplitude >30 mmHg, and duration >6 s at more than 1 recording site) were not more frequent in patients than in controls. During phase 2, persistent low amplitude contractions in all recording sites and sustained tonic pressure increases (>10 min in one recording site) were found only in parenteral nutrition-dependent children. We conclude that there are five features having a clear association with pediatric gastrointestinal motility disorders: 1) absent phase 3, 2) abnormal phase 3 migration, 3) short intervals between phase 3s, 4) persistent low amplitude contractions, 5) sustained tonic contractions. These results suggest that several qualitative features of antroduodenal manometry considered abnormal in adults may be within the spectrum of normal variation in children.