Contribution of manometry to the management of gastroesophageal reflux in infants and children

Gastroesophageal reflux (GER) is common in pediatric patients. When investigations are needed, preference is given to pH recording to establish the diagnosis of GER and to upper gastrointestinal tract endoscopy to look for evidence of esophagitis. Manometry is indicated only in selected cases. Manometry is useful for elucidating the mechanisms involved in severe GER that fails to respond to conservative therapy, in order to select the most appropriate treatment. In addition, demonstration of esophageal dyskinesia or of hypotonia of the lower esophageal sphincter is of great prognostic significance. Manometry has benefited from significant technical advances over the last few years, in particular due to the introduction of computerized methods. Coupled manometry and pH recording, and prolonged ambulatory manometric recording will be available in the near future. These techniques will provide new data on the pathophysiologic mechanism of GER in pediatric patients.