Durability of Esophageal Motor Disorders Identified on High-Resolution Esophageal Manometry: A Case Series
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CASE SERIES
Durability of Esophageal Motor Disorders Identified on High-Resolution Esophageal Manometry: A Case Series Annumeet Sandhu . Mohamed Eisa . Takahisa Yamasaki . Fahmi Shibli . Ronnie Fass
Received: February 14, 2020 Ó The Author(s) 2020
ABSTRACT Background/Aim: Diagnosis of esophageal motor disorders using high-resolution esophageal manometry (HREM) may result in medical, endoscopic or surgical intervention. However, prior to any intervention, durability of the HREM findings should be established. The aim of this case series was to assess 25 patients who had undergone HREM twice, at least 6 months apart, and to determine the durability of the initial manometric diagnosis. Methods and Patients: This is a case series of 25 patients who underwent HREM at least twice, 6 months apart, at a large safety net hospital. All patients were evaluated in between the tests for any clinical intervention. Demographics, patients’ indication for HREM and clinical presentation were documented as well.
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12034650. A. Sandhu M. Eisa T. Yamasaki F. Shibli R. Fass (&) Division of Gastroenterology and Hepatology, The Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA e-mail: [email protected]
Results: Of the 25 patients, HREM results improved in 32%, worsened in 20% and were unchanged in 48%. Some interventions were employed between the first and second HREM diagnosis. Those associated with an improved diagnosis included doubling the proton pump inhibitor (PPI) dose, re-starting a PPI, adding a histamine 2 blocker (H2 blocker) and use of empiric dilation. Conclusions: In this case series, about half of the patients undergoing two esophageal manometries, at least 6 months apart, demonstrated lack of durability of their initially diagnosed esophageal motor disorder. Keywords: Dysphagia; Esophageal manometry; Esophageal motility; Heartburn; Proton pump inhibitors
Adv Ther
Key Summary Points Durability of non-achalasic esophageal motor disorders remains unknown. Presently, the assumption is that the presence of hypercontractile or hypocontractile esophageal motor disorder on first esophageal manometry is a long-term diagnosis. In this study we evaluated patients with esophageal motor disorders who underwent a repeat manometry at least 6 months apart. The study demonstrated that 50% of the patients assessed had either a normal or a different esophageal motor disorder on a repeat esophageal manometry.
INTRODUCTION Today, HREM is considered the gold standard for diagnosing esophageal motility disorders [1]. The Chicago classification was developed to help interpret the high-resolution manometric findings and thus facilitate diagnosis of esophageal motor disorders. Esophageal motility disorders have been classified into major (distal esophageal spasm, jackhammer esophagus, achalasia, esophagogastric junction outflow obstruction and absent contractility) an
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