Fellow Northwestern University Feinberg School of Medicine Chicago, IL
Award: Presidential Poster Award
Dustin A. Carlson, MD, MSCI, Alexandra J. Baumann, DO, Erica N. Donnan, MD, John E. Pandolfino, MD, MSCI, FACG; Northwestern University Feinberg School of Medicine, Chicago, IL
Introduction: Functional dysphagia is defined by Rome IV criteria as sensation of abnormal bolus transit through the esophagus in the absence of a structural or mucosal cause on endoscopy and absence of major esophageal motor disorder on high-resolution manometry (HRM). The functional luminal imaging probe (FLIP) and provocative HRM (pHRM) may identify abnormalities not detected by the standard evaluation with endoscopy and HRM. We aimed to assess the prevalence and association of abnormal esophagogastric junction (EGJ) opening on FLIP and abnormalities on pHRM among patients with functional dysphagia. Methods: Adult patients evaluated for dysphagia with normal endoscopy, HRM with normal motility on standard supine swallow protocol that completed FLIP and HRM with solid swallows and rapid-drink challenge (RDC) were retrospectively identified. FLIP (16-cm) was performed during sedated endoscopy. The EGJ-distensibility index (DI) was calculated at the 60ml fill volume and maximum achieved EGJ diameter assessed across the entire FLIP study. Abnormal EGJ opening was defined by EGJ-DI < 3.0 mm2/mmHg and maximum EGJ-diameter < 16mm. Obstructive features on provocative HRM were considered with integrated relaxation pressure (IRP) >15mmHg with solid (cracker) swallows, IRP >12mmHg during RDC, or panesophageal pressurization (PEP) during RDC. Results: 104 patients, mean (SD) age 49 (17) years, 79% female, were included. Among the whole cohort, the median (interquartile range) EGJ-DI was 4.3 (2.2-6.4) mm2/mmHg, maximum EGJ-diameter was 20.1 (17.6-24.9)mm, solid IRP was 10 (6-15)mmHg, and RDC-IRP was 2.3 (0.6-5)mmHg. 43 (41%) patients had either abnormal FLIP or an obstructive feature of pHRM. 20 (20%) patients had abnormal EGJ opening on FLIP and 34 (33%) patients had obstructive features on pHRM: 27 by solid-IRP, 5 by RDC-IRP, 12 by PEP on RDC; 10 had >1 feature. 11/20 (55%) patients with abnormal FLIP had an obstructive feature on pHRM while 61/84 (73%) with normal FLIP had normal pHRM; P=0.032. Discussion: Abnormal EGJ opening on FLIP and obstructive features on pHRM were detected in 41% of patients otherwise classified as functional dysphagia, while 10% had abnormalities both on both FLIP and pHRM. A comprehensive esophageal evaluation may identify functional abnormalities among patients classified as functional via standard approaches. Future directions include assessing potential for response to targeted therapy, such as dilation, in this cohort.
Disclosures: Dustin Carlson: Medtronic – Consultant, Speaker's Bureau, Other Financial or Material Support, Licensing agreement. Alexandra Baumann indicated no relevant financial relationships. Erica Donnan indicated no relevant financial relationships. John Pandolfino: Crospon – Stockholder/Ownership Interest (excluding diversified mutual funds). Given Imaging – Consultant, Grant/Research Support, Speaker's Bureau. Medtronic – Consultant, Speaker's Bureau, Other Financial or Material Support, Licensing agreement. Sandhill Scientific – Consultant, Speaker's Bureau.