Pediatric esophageal motility disorders: studies on (patho)physiology, diagnosis and management

Pediatric esophageal motility disorders cover a wide spectrum of disorders, varying in prevalence, severity and symptom burden. This thesis comprises of studies on the (patho)physiology, diagnosis and management underlying gastroesophgeal reflux (GER) episodes, (presumed) GER related extraesophageal symptoms and the motility disorder achalasia. The value of novel diagnostic techniques in pediatric gastroesophageal reflux disease (GERD) and motility disorders and the treatment of pediatric GERD with acid suppression are explored. The final part of the thesis describes a study on the prevalence, characteristics and management of pediatric achalasia in the Netherlands. The results of the presented studies in this thesis indicate the need to rethink our current diagnostic and treatment approach towards pediatric GERD and the need to develop novel diagnostic tools and treatment strategies. We provided a basis for more clinical and laboratory-based research, looking further into the mechanisms behind triggering of the main mechanism underlying GERD: transient lower esophageal sphincter relaxations. Furthermore, we identified a relationship between protonpump inhibitor treatment and respiratory complications in patients admitted at the pediatric intensive care unit (PICU). Acid suppression therapy in pediatric patients might not prevent extra-esophageal reflux symptoms and potentially increases the risk of (secondary) respiratory infections, especially in PICU patients. Finally, the data on diagnosis and clinical management of a Dutch pediatric achalasia shows there is a need to internationally cooperate and ensure optimal management of this severe motility disorder at a pediatric age.