Assistant Professor of Medicine Duke University Medical Center Chapel Hill, North Carolina
David A. Leiman, MD, MSHP1, Amit Patel, MD2; 1Duke University Medical Center, Chapel Hill, NC; 2Duke University School of Medicine, Durham VA Medical Center, Durham, NC
Introduction: While dysphagia symptoms may increase with age, study of the relationships between age and esophageal motor disorders have primarily been restricted to conventional manometry, not high-resolution manometry (HRM). Therefore, we aimed to evaluate the associations between age and esophageal motor diagnoses on HRM.
Methods: We performed a retrospective study of consecutive adults undergoing esophageal HRM studies at three motility labs over a 2-year period. Demographic data, including age and gender, were collected. HRM studies performed as part of pulmonary transplant evaluation protocols, as well as incomplete or uninterpretable studies, were excluded. HRM studies were analyzed per Chicago Classification (CC) v3.0. Diagnoses were further categorized by whether they were “actionable;” for this report, actionable HRM diagnoses included achalasia, esophagogastric junction outflow obstruction, jackhammer esophagus, and diffuse esophageal spasm. To evaluate the relationships between HRM diagnosis and predictive factors, chi-square, t-tests, and linear regression models were used as appropriate. Results: 617 patients (median 62±14 yrs, 47.3% F) met inclusion criteria. 54.9% of HRM studies were normal; 19.8% had achalasia spectrum disorders (Table 1). Ationable diagnoses were seen in 25.5% of studies. Proportions of normal HRM studies were significantly lower with increasing age (p=0.01), though age was not significantly associated with individual diagnoses (p=0.052) or CC diagnosis group (p=0.061). However, those ³60 years of age were significantly more likely to have an actionable motor diagnosis (p=0.029), and the proportions of actionable diagnoses increased with age (Figure 1). Male gender was associated with a significantly higher proportion of actionable diagnoses (p=0.001). In a multivariable regression model including age, gender, and center, fragmented peristalsis was the only CC diagnosis independently associated with age (p=0.049). Discussion: Consistent with previous studies evaluating diagnostic yield of conventional manometry, we found that increasing age was associated with decreasing likelihood of normal HRM. While individual CC diagnoses were not associated with age, actionable diagnoses were significantly associated with age ³60 years. Although additional factors may contribute, our findings suggest that esophageal HRM has value in the evaluation of elderly patients with dysphagia.
Table 1. In a univariate analysis, there were no significant differences in individual high-resolution manometry (HRM) Chicago Classification v3.0 diagnoses by age group (*p>0.05 for all individual CC diagnoses). However, there was a significant association between age 60 years and an actionable HRM diagnosis (defined as whether available therapeutic interventions could reliably improve patient symptoms).
Figure 1. The proportions of actionable esophageal high-resolution manometry (HRM) Chicago Classification v3.0 diagnoses (shown in blue) increased with increasing age.
Disclosures: David Leiman indicated no relevant financial relationships. Amit Patel indicated no relevant financial relationships.