Introduction: Esophageal Motility disorders are currently classified on the basis of Chicago classification 3.0 which includes the major motility disorders Achalasia, Esophagogastric Junction Outflow Obstruction (EGJOO), Jackhammer Esophagus (JE) and Distal Esophageal Spasm (DES) and minor disorders like Ineffective Esophageal Motility (IEM) and Fragmented Peristalsis (FP). Normal esophageal pressures are estimated to be between 30-180 mmHg. Under Chicago classification these are reported as Distal Contractile Integral (DCI), a collective measure of the smooth muscle contractility of the esophagus. Methods: Retrospective chart review of all patients presenting to our motility department for esophageal manometry from Apr 2018 to Mar 2020.Studies were classified based on Chicago classification. Smart mouse analysis of distal 2/3 of esophagus was done using Manoview 3.3 software to look for maximum contractile pressures on all individual swallows. 278 patients were evaluated.Distal esophageal pressures over 200mmHg in peristaltic waveform with no other known disorder based on Chicago classification were classified as Focal Hypercontractility (FH). Chi square analysis was used for statistical analysis. Results: 194(70%) of the patients were female. FH was the commonest manometric signature seen in 44 (15.8%) of the patients followed by EGJOO which was seen in 33 (11.9%) of the patients.. JE was present in 15 (5.4%) of the patients, Achalasia in 17 (6.1%), and DES in 2 (0.7%).13 (4.7%) patients had more than one manometric signature. The commonest presenting symptom was dysphagia followed by GERD and atypical chest pain. FH is the most frequent abnormal manometric signature noted in symptomatic patients presenting for manometry evaluation and was significantly higher when compared to frequency of Achalasia, JE, and DES (P< 0.05) and was also more frequent than EGJOO (P=0.15)) Discussion: Despite not being a part of Chicago classification 3.0 nomenclature, FH is the commonest abnormal manometric signature noted in symptomatic patients evaluated with manometry at our quaternary center. Focal contractions may reach exceedingly high numbers (250-400 mmHg) without meeting abnormality criteria under the current system unless the overall Distal Contractile Integral crosses 8000mmHgcmsec to meet criteria for JE. There is an immediate need to redefine the criteria to avoid classifying these signatures as normal.
Manometric Signatures in Symptomatic Patients
Disclosures: Tarun Sharma indicated no relevant financial relationships. Kristin Ciezki indicated no relevant financial relationships. Megan Jacobson indicated no relevant financial relationships. Nilay Kumar indicated no relevant financial relationships. Maharaj Singh indicated no relevant financial relationships.