Addendum to A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery

To the Editor,

I refer to the article ‘A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery’ ¹ suggesting that high-resolution manometry (HRM) with impedance may play a role in establishing risk for new or persisting dysphagia in children undergoing Nissen fundoplication for primary gastroesophageal reflux disease (GERD). Specifically, in the setting of a normal esophageal body motility diagnosis (per Chicago Classification v3.0), GERD patients with dysphagia postoperatively were distinguishable by an elevated pressure flow index (PFI). Importantly, the prognostic value of PFI was superior when viscous boluses of extremely thick consistency were used during swallow challenges. However, without access to software to perform esophageal pressure flow analysis, these results were not readily generalisable.

Medical practice has undergone substantial innovation and modernisation though use of the internet. Swallow Gateway™ is a cloud-based open resource (available at: www.swallowgateway.com) that is able to read and analyse HRM studies acquired with commercial systems. In addition, this innovation is designed to facilitate secure communication and data sharing, thus is ideal for conducting evidence-based medical research in the context of HRM. In relation to data from the above-mentioned study, Swallow Gateway-based reanalysis has yielded similar results (see Figure 1). Caution is recommended as the study had several limitations which were discussed in the original paper. It is hoped that the updated information provided by this addendum, however, will inform the design of larger prospective studies addressing the topic of dysphagia following antireflux surgery.

Figure 1.

Prognostic value of Swallow Gateway-derived pressure flow index (PFI) for predicting esophageal dysphagia symptoms. Thirteen children (aged 6.8–15.5 years) undergoing work-up prior to 360-degree Nissen fundoplication. A dysphagia score assessed symptoms at pre- and postoperative time points. Only data for 5 ml extremely thick consistency boluses are shown as these were the most predicative of outcome. (a) Grouping of individual patients by pre- and postoperative dysphagia symptom scores. (b) Individual preoperative PFI results for patients grouped for postoperative dysphagia status (as in (a)). (c) Preoperative PFI in patients ranked by postoperative dysphagia outcome (best to worst). (d) Scatter plot of postoperative dysphagia score vs preoperative PFI (r and p value is for Spearman Rank correlation). (e) Receiver operator characteristic (ROC) curve for preoperative PFI as a dichotomous predictor of a postoperative dysphagia; any dysphagia and dysphagia score >10 (of maximum 45). sens: sensitivity; spec: specificity.