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Background: Small bowel manometry (SBM) has widely been used to investigate adult patients with gastrointestinal motility disorder. However, the use of this technique to paediatrics is uncommon. The aim of this study was to evaluate feasibility of SBM on paediatric patients with suspected small intestinal motility disorder. Methods: We have performed SBM on 14 paediatric patients (age range 2-10 years) who had symptom(s) including recurrent abdominal pain (n = 10), nausea (n = 5), vomiting (n = 7), abdominal distension (n = 2) and constipation (n = 2). A 3-channel manometry catheter was introduced nasally and placed in the proximal small bowel under fluoroscopic control. Ambulatory recordings were made for 24 hours using a portable recorder. Recorded data were analysed using dedicated software. Results: Four had normal motility when applied to the normal ranges in adults. At least one of the following abnormalities was found in eight patients; possible neuropathy findings including excess of motor activity (n = 3), prolonged Phase III (n = 2), Phase III-like prolonged bursts (n = 3), non-propagated Phase III (n = 2), retrograde propagation of Phase III (n = 2), and Iow-amplitude Phase III (n = 1) suggesting possible myopathy. Intubation failed in two patients due to no migrations of the catheter into the small intestine. Summary: In this study a high proportion of the patients had abnormal small intestinal motility and this suggests that SBM can be used to evaluate those conditions. Normal values during infant and childhood development need establishing before adopting the technique for clinical diagnosis. [ABSTRACT FROM AUTHOR]

Sphincter of Oddi dysfunction (SOD) is a cause of postcholecystectomy pain. Current gold-standard diagnosis is by measurement of basal pressure by sphincter of Oddi manometry (SOM), and if elevated an endoscopic sphincterotomy (ES) is performed. Both these procedures carry significant complication rates. Hepatobiliary scintigraphy has been promoted as a means of assisting management. Aim: to evaluate hepatobiliary scintigraphy (HBS) as a means of screening for SOD and predicting treatment response. Methods: 21 post-cholecystectomy patients were screened by HBS prior to standard evaluation with SOM during ERCP. HBS was performed using a standard protocol. A semi-quantitative scoring system classified scans as positive (SOD) or negative (no SOD). Two observers reviewed all 21 scintigrams. SOM was regarded as diagnostic of SOD if sphincter base pressure was > 40 mm Hg. If elevated, an ES was performed and a successful result was defined as an improvement in symptoms. Results: 17 of our patients were female, average age 42.4 + 4.0 years. Agreement was 100% between observers. Conclusions: HBS can be interpreted reliably between observers. HBS is a poor screening tool in isolation, but may prove a useful adjunct to manometry in predicting ES outcome. [ABSTRACT FROM AUTHOR]

23 Children aged between 11 months and 15.5 years were seen in our clinic within the period October 01 2001-2002. They presented with feeding difficulties that required oesophageal manometry, among other diagnostic investigations. The commonest symptoms were dysphagia for solids, regurgitation, and vomiting, in order of frequency. Lower Oesophageal Sphincter (LOS) pressure and body motility were measured using a standard eight channel, water perfused adult catheter (3.9 mm diameter) or a 2.3 mm catheter purpose designed for paediatric use (Mediplast). LOS pressure and oesophageal body motility were measured using a Flexilog 4000 recording system. Nine out of 23 patients had a hypertensive LOS (pressure > 26 mm Hg). These patients with hypertensive LOS but without achalasia often had regurgitation and vomiting as major presenting symptoms. Only 2 out of 23 patients had achalasia and only one of the two had a hypertensive LOS. Non-specific motility disorder (7/23), in which there were few peristaltic waves with a majority of simultaneous contractions, was the commonest cause of dysphagia. Of significance was a subgroup (4/23) with a partially relaxing LOS (residual pressure 6-11 mm Hg) but who did not have achalasia. This group had varied symptoms such as vomiting, regurgitation, and dysphagia for solids. A large hiatus hernia (7 cm) was the only finding in an adolescent girl with unexplained vomiting, normal oesophageal body motility, and "normal" OGD. in summary, children with feeding problems who present with regurgitation, vomiting, and dysphagia for solids are most likely to have a hypertensive LOS or non-specific oesophageal dysmotility rather than achalasia. Unexplained vomiting with normal LOS function and body motility may be due to hiatus hernia, which could be missed during OGD. In conclusion, oesophageal manometry is an essential diagnostic tool in the investigation of upper gastrointestinal manifestations. From our experience, it is best suited to... [ABSTRACT FROM AUTHOR]