Distal contractile integral measurement and vascular compression in the esophagus: a problem unsolved?
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ORIGINAL ARTICLE
Distal contractile integral measurement and vascular compression in the esophagus: a problem unsolved? Rafael Lima Kahwage1 · Ricardo Brandt de Oliveira1 Received: 3 October 2019 / Accepted: 14 April 2020 © The Japan Esophageal Society 2020
Abstract Background Distal contractile integral (DCI) is influenced by factors other than esophageal smooth muscle contractility, such as intrabolus pressure and vascular and respiratory movements’ artifacts. We aimed to determine the size of the contribution of pressures generated by vascular compression on the esophagus to the DCI measured in HRM recordings in symptomatic patients. Methods HRM manometry recordings obtained from 383 subjects referred to the GI motility laboratory at a tertiary center (2012–2016) were evaluated by visual inspection for evidence of strong vascular compression (SVC) of the esophagus. Clinical, demographic, manometric, and serologic data for Chagas disease were obtained. Subjects were classified, respectively, as asymptomatics (ASYM) or symptomatics (SYMP). DCI and SVC-DCI were measured, and the SVC-DCI/DCI ratio was expressed as a percentage and the difference between DCI and SVC-DCI (neat-DCI) was calculated. DCI, SVC-DCI, SVCDCI/DCI % and neat-DCI from SYMP and ASYM were compared. Results SVC was conspicuous in 42 of 383 subjects (11%). In 33 subjects, SVC was detected only in supine position. SVC was localized in middle esophagus in 21 subjects (50%), in distal esophagus in 12 subjects (29%) and in both regions in 9 subjects (21%). In 9 subjects, SVC vanished from the swallowing window analysis (21%). Conclusions SVC is a common finding in esophageal HRM study, particularly in the supine position. Occasionally, its contribution to DCI value is sufficiently great to masquerade esophageal hypocontractility. Different manometric protocols may be required in patients with SVC. Keywords Strong vascular compression · Esophagus · Manometry · Distal contractile integral Abbreviations ASYM Asymptomatics or asymptomatic group SYMP Symptomatics or symptomatic group HRM High-resolution manometry DL Distal latency DCI Distal contractile integral EMD Esophageal motility disorders IEM Ineffective esophageal motility SVC Strong vascular compression SVC-DCI Strong vascular compression measured by DCI tool * Rafael Lima Kahwage [email protected] 1
Division of Gastroenterology, Department of General Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14048‑900, Brazil
SVC-DCI/DCI % Median SVC-DCI/DCI percentage contribution to final median DCI IQR Interquartile range
Background The Chicago Classification of esophageal motility disorders (EMD) is widely used to analyze esophageal motility recordings obtained with high-resolution manometry (HRM) study [1]. The status of the esophageal contractile function is evaluated by the distal latency (DL) and the distal contractile integral (DCI). DL is a metric of the rate of contraction propaga
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