Wake Forest Baptist Health Winston-Salem, North Carolina
Troy Pleasant, MD1, Steven Clayton, MD2; 1Wake Forest Baptist Health, Winston-Salem, NC; 2Wake Forest University, School of Medicine, Winston-Salem, NC
Introduction: The manometric diagnosis of esophagogastric junction outflow obstruction (EGJOO) can be ambiguous and not indicate true functional obstruction at the lower esophageal sphincter (LES). The aim of our study was to identify the presence of impaired esophageal bolus clearance in patients with EGJOO diagnosed via high-resolution manometry (HRM), and compare to a group controls (patients with normal HRM studies) who presented with dysphagia and similar symptoms. Methods: 12 months of High-Resolution Impedance Manometry (HRIM) results at a large academic center (Wake Forest Baptist Medical Center) were reviewed. Studies diagnostic for EGJOO based on the Chicago Classification of Esophageal disorders (CCv3) were identified. In the group of patients with EGJOO, those with impaired bolus clearance were identified. Impaired bolus clearance was defined as patients with bolus clearance < 80%. As a control, a group of HRIM labeled as normal studies were also identified. Incidence of impaired bolus clearance in this group was also recorded, and later compared to that of the EGJOO group. Results: After reviewing the HRIM results, 121 patients were found to have HRIM consistent with the diagnosis of EGJOO. Another 121 patients were identified as having normal manometries. Using the criteria for impaired bolus clearance (< 80%), each group was divided into normal vs impaired clearance. In the EGJOO group, 64 (52.9%) patients were found to have impaired clearance, vs 57 (47.1%) which had normal bolus clearance. This was compared to the normal HRIM group, where 16 (13.2%) patients were found to have impaired bolus clearance, while 105 (86.8%) patients were found to have normal bolus clearance. Using a chi square calculation, results were found to be significant (p < .01). Table 1 summarizes demographics. Table 2 summarizes the bolus clearance data. Discussion: Patients with EGJOO diagnosed with HRIM were found to have significantly impaired bolus clearance compared to normal subjects. Abnormal liquid bolus transit on impedance analysis may be a useful measure to define clinically significant outflow obstruction. Further investigation of these patients’ subsequent studies, such as timed barium esophagrams, is warranted to fully assess esophageal emptying.
Table 1: Demographics
Table 2: Results
Disclosures: Troy Pleasant indicated no relevant financial relationships. Steven Clayton indicated no relevant financial relationships.