INDICATION FOR PEDIATRIC.doc

Journal of Pediatric Gastroenterology and Nutrition Volume 24, 616-618.? 1997, Lippincott-Raven Publishers. INDICATIONS FOR PEDIATRIC ESOPHAGEAL MANOMETRY: A MedicalPosition Statement of the North AmericanSociety for Pediatric Gastroenterologyand Nutrition ? Mark A. Gilger, MD, Department of Pediatrics, Texas Children’s Hospital, Baylor Medical College John T. Boyle, MD, Department of Pediatrics, Rainbow Babies and Children’s Hospital Judith M. Sondheimer, MD, Department of Pediatrics, Children’s Hospital, University of Colorado Richard B. Colletti, MD, Department of Pediatrics, University of Vermont College of Medicine ? INTRODUCTION Recently the American Gastroenterological Association published a medical position statement on the clinical use of esophageal manometry1, accompanied by a technical review.2 These documents are a comprehensive description of basic esophageal physiology and manometry, technical aspects and limitations of manometric recordings, and the clinical applications of esophageal manometry in the adult patient. Because the approach to the child with esophageal disorders is different, the North American Society for Pediatric Gastroenterology and Nutrition has prepared the following medical position statement. ESOPHAGEAL PHYSIOLOGY IN CHILDREN Swallowing is a complex process initiated by the voluntary ingestion of food and followed by the involuntary or automatic actions of the oropharynx and the esophagus. The esophageal phase of the swallow involves the transport of the food bolus into the stomach. The three structural components of the esophagus are the upper esophageal sphincter (UES), the esophageal body, and the lower esophageal sphincter (LES).3 The UES, defined as an area of increased pressure between the pharynx and the esophageal body, is present by at least 32 weeks of gestation and is functional at birth. 4 However, swallowing coordination may be poor in the first week of life and in premature infants 1500 g. 4-6 Structurally, t