Xiaowen Fan, MD1, Il J. Paik, MD2, Xiaocen Zhang, MD1, Gassan Kassim, MD1, Melissa Hershman, MD3, Elijah Verheyen, MD1, Jean Abed, MD1, Michael S. Smith, MD, MBA4
1Mount Sinai St. Luke's and Mount Sinai Roosevelt, New York, NY; 2University of Miami Health System, Miami, FL; 3Mount Sinai Beth Israel Medical Center, New York, NY; 4Mount Sinai West and Mount Sinai St. Luke's Hospitals, New York, NY
Introduction: High resolution manometry (HRM) is a widely utilized diagnostic tool for identifying esophageal motility disorders. The Chicago Classification V3.0 (CC3) applies a hierarchical stepwise approach to the analysis of HRM parameters, allowing for characterization and diagnosis of different disorders. While upper esophageal sphincter (UES) parameters are not utilized in CC3, studies have shown that these values could potentially help in differentiating between different disorders. The aim of this study was to evaluate for trends in esophageal sphincter parameters in patients with absent contractility (AC).
Methods: Reports for esophageal HRM performed at a single referral-based motility center between 2013 and 2018 were retrospectively analyzed. We selected patients diagnosed with either AC (study group) or no CC3 abnormality (control group), and divided them by age group. The primary outcome included differences in parameters related to both the lower esophageal sphincter (LES) and UES. Multivariate regression analysis was used to adjust for age group and sex.
Results: A total of 455 patients were included in the study (Figure 1), 52 with AC (mean age 51.4, 50.0% female) and 403 without CC3 abnormality (mean age 52.8, 69.5% female). The primary indication for HRM was more likely to be dysphagia in AC patients (73.1% vs 30.5%, p< 0.01), whereas GERD was more likely to be reported in controls (67.2% vs 25.0%, p< 0.01). AC diagnosis was associated with a lower LES mean basal pressure (14.9 vs 27.0 mmHg, p< 0.01) and LES mean residual pressure (5.9 vs 7.9 mmHg, p< 0.01). However, UES mean residual pressure (2.1 vs 0.1 mmHg, p=0.02) and UES mean relaxation time to nadir (296.4 vs 228.5 ms, p=0.04) were significantly higher compared to control. No significant difference in UES mean basal pressure was identified between the study group and control.
Discussion: AC affects both the LES and UES, causing decreased LES basal and residual pressures, along with increased UES residual pressures and UES relaxation time to nadir. Our data suggest that AC affects smooth muscle in both the esophageal body and LES, where it causes decreased LES tone. The increased UES residual pressures and relaxation time to nadir might be compensatory adaptation to poor esophageal bolus clearance to prevent esophago-pharyngeal reflux. Utilization of UES parameters in future versions of the Chicago Classification may help users better diagnose and manage AC and related disorders.
Citation: Xiaowen Fan, MD; Il J. Paik, MD; Xiaocen Zhang, MD; Gassan Kassim, MD; Melissa Hershman, MD; Elijah Verheyen, MD; Jean Abed, MD; Michael S. Smith, MD, MBA. P0278 - HIGH RESOLUTION MANOMETRY FINDINGS IN PATIENTS WITH ABSENT CONTRACTILITY. Program No. P0278. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.