Layth Al-Jashaami, MD1, Mustafa Alani, MD2, Bijun Sai Kannadath, MBBS, MS1, Shifat Ahmed, MD1, Sarabdeep Mann, MD1, Sushovan Guha, MD, PhD1, Michael Mills, MD2, Shiva Ratuapli, MD2
1University of Arizona College of Medicine, Phoenix, AZ; 2University of Arizona, Phoenix, AZ
Introduction: High resolution manometry (HRM) is a valuable tool increasingly used in clinical practice for diagnosis of esophageal disorders. Impedance measurement was recently added to the manometry catheter to assess bolus clearance. However, clinical utility of this metric and its association with esophageal motility disorders are currently unknown. The aims of this study are to a) evaluate the association between strength of peristalsis and bolus clearance and b) compare the strength of peristalsis and bolus clearance between normal patients and patients with various esophageal motility disorders.
Methods: A retrospective review of patients referred for HRM at our tertiary academic center from January 2016 to October 2018 was performed. All studies were interpreted by two HRM-trained GI specialists and reported in accordance with the Chicago classification of esophageal motility disorders, version 3.0. Distal Contractile Integral (DCI) was used to measure strength of peristalsis. Bolus clearance was measured by visual assessment of color topography clearance of bolus in each swallow. Greater than 50% complete bolus clearance was considered as effective peristalsis. Demographic and manometry data were analyzed using STATA 15.1.
Results: 1,323 consecutive studies were included in the analysis. The mean age was 59.6± 14.5 years. Of these 898 (67.9%) were women. Women were overall older with an average of 60.1 ± 0.5 years compared to men (58.5 ± 0.8 Years, p= 0.0332). The most commonly diagnosed motility disorder was ineffective esophageal motility (IEM) (284, 21.5%). There was moderate correlation between DCI and intrabolus pressure (r=0.29, p < 0.001). Patients with normal esophageal motility had higher DCI (1875.9 vs 551.8, p < 0.0001) and complete bolus clearance (85.8% vs 56.8%, p < 0.0001) compared to patients with IEM. In contrast, patients with spastic motility disorders (Achalasia and Esophagogastric Junction Outflow Obstruction) had lower bolus clearance (43.2% vs 85.2%, p < 0.0001) despite higher DCI than normal patients (4661 vs 1875, p< 0.0001). ROC analysis showed that a DCI of 320 mmHgcm2 had greater accuracy in predicting complete clearance of bolus in >50% of swallows (96.5% sensitivity, 24.8% specificity) compared to 450 mmHgcm2 (accuracy 83.1% vs 79.3%, p < 0.0001).
Discussion: In our large cohort of patients, HRM peristaltic metrics suggest that a DCI cut-off value of 320 mmHgcm2 had greater accuracy for predicting complete bolus clearance.
Citation: Layth Al-Jashaami, MD; Mustafa Alani, MD; Bijun Sai Kannadath, MBBS, MS; Shifat Ahmed, MD; Sarabdeep Mann, MD; Sushovan Guha, MD, PhD; Michael Mills, MD; Shiva Ratuapli, MD. P2084 - STRENGTH OF PERISTALSIS AND ITS ASSOCIATION WITH BOLUS CLEARANCE IN ESOPHAGEAL MOTILITY DISORDERS. Program No. P2084. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.