Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease
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ORIGINAL ARTICLE
Esophageal Function Tests are Not Associated with Barium Swallow Findings in Advanced Lung Disease Shai Posner1 · Kurren Mehta2 · Alice Parish3 · Donna Niedzwiecki3 · Rajan T. Gupta4 · Deborah A. Fisher1,5 · David A. Leiman1,5 Received: 30 August 2019 / Accepted: 3 April 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Gastroesophageal reflux disease and esophageal dysmotility are common in patients with advanced lung disease (ALD) and are associated with worse outcomes. Assessing esophageal function in these patients is relevant for determining pulmonary transplant eligibility and prognosticating post-transplant outcomes. Barium Swallow (BaS) is a non-invasive testing modality often performed as a complement to formal esophageal function tests (EFTs), but its role and clinical utility in this context is unknown. Therefore, we aimed to determine the relationship between BaS and EFTs with high-resolution manometry (HRM) and 24-h ambulatory pH-metry in patients with ALD. We performed a retrospective study of 226 consecutive patients undergoing evaluation for lung transplantation at a single center. All patients underwent EFTs and BaS independent of clinical history or symptoms per institutional protocol. Appropriate statistical tests were performed to evaluate the relationship between EFTs and BaS. Mucosal, reflux and motility findings were categorized. Abnormal motility was reported in 133 (59%) patients by BaS and 99 (44%) by HRM, with a significant difference in the proportions of patients with abnormal studies (p 18 years of age) evaluated for lung transplantation were eligible. To minimize variation in radiographic interpretation, patients were excluded if they did not complete pre-transplant BaS at our institution. Demographic data including age, sex, body mass index (BMI), etiology of lung disease and survival were obtained from the electronic health record. Data also were collected on results of HRM, pH-metry and BaS. Patient symptoms were abstracted from a standardized questionnaire performed at the time of HRM [11].
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Esophageal Function Testing Patients underwent EFTs as we have previously described [11, 23]. All HRM were performed in the supine position. HRM data were interpreted by three esophagologists (DAL, RKW, RAS) and motility diagnoses were reported based on the Chicago Classification (CC) v 3.0 [24]; hypercontractility motility disorders included jackhammer esophagus and distal esophageal spasm; disorders of hypocontractility included absent peristalsis, ineffective esophageal motility and fragmented peristalsis; disorders of the esophagogastric junction included EGJ outflow obstruction and achalasia. Additional data including mean distal contractile integral (DCI), lower esophageal sphincter integrated relaxation pressures (LES-IRP), and lower esophageal sphincter mean-basal pressure (LESMBP) were collected. For ambulatory pH-monitoring, all studies were performed after stopping proton-pump inhibitors at least 5 days and histamine-2 recepto
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