Using FLIP to Study Motility Disorders in Children

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Motility researchers from Children’s Hospital of Philadelphia (CHOP) published two recent papers about the use of the functional luminal imaging probe (FLIP) to improve symptoms in pediatric patients with achalasia and eosinophilic esophagitis (EoE).

The first paper, “Use of the functional luminal imaging probe in pediatrics: A comparison study of patients with achalasia before and after endoscopic dilation and non-achalasia controls,” was published April 19, 2021, in Neurogastroenterology & Motility. Read the study abstract on PubMed.

The retrospective study examined pediatric patients with achalasia who underwent FLIP before and immediately after balloon dilations and compared them to a non-achalasia cohort. Previous researchers discovered FLIP was helpful in assessing changes in esophagogastric junction (EGJ) distensibility during dilations in adult patients, but limited information was available about its use in children.

The recent study by researchers at CHOP focused on getting that information. They discovered a reduction in EGJ distensibility in pediatric patients with achalasia before dilation, and a significant increase in EGJ distensibility immediately after dilation – compared to similar studies in adults. This information will help clinicians improve interpretation of FLIP studies and the tool’s overall use in pediatrics.

Study authors included several physician-researchers from CHOP’s Division of Gastroenterology, Hepatology and Nutrition, the Suzi and Scott Lustgarten Center for Gi Motility, Center for Pediatric Inflammatory Bowel Disease and Kohl’s GI Nutrition and Diagnostic Center, including Alain J. Benitez, MD; Stephen A. Budhu, MPH, BS; Amit A. Shah, MD; Kristin N. Fiorino, MD; Amanda B. Muir, MD; and Petar Mamula, MD.

A second study, “Esophagogastric junction compliance in pediatric eosinophilic esophagitis and achalasia,” was co-written by gastroenterologists at CHOP and Rady Children’s Hospital, San Diego, CA. While previous studies demonstrated a reduction in esophagogastric junction (EGJ) and esophageal distensibility in patients with achalasia and EoE, none had examined the potential role of EGJ compliance in the management of the two conditions.

After examining a small cohort of patients, researchers felt the pattern of results showed reduced EGJ compliance in patients with EoE-related symptoms like those found in untreated patients with achalasia. Authors recommended further study in larger cohorts to explore the potential role EGJ could have on disease management of patients with both conditions.

Lead authors in the second study included Drs. Benitez, Budhu, Muir, Fiorino, Mamula and Hayat Mousa, MD, Director of the Suzi and Scott Lustgarten GI Motility Center.

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