Marilia Montenegro, MD, Monia Werlang, MD, Alfred D. Nelson, MBBS, Brian E. Lacy, MD, PhD, FACG; Mayo Clinic, Jacksonville, FL
Introduction: Asthma and gastroesophageal reflux (GERD) are two closely related conditions. Asthma can be an extra-intestinal manifestation of GERD; GERD can be a trigger for asthma. Conventional solid state manometry showed that esophageal dysfunction is common in asthmatic patients even without typical GERD symptoms. Ineffective esophageal motility (IEM) and hypotonic lower esophageal sphincter (LES) were the most common abnormalities previously reported, the latter being associated with the use of inhaled medications such as albuterol. There are no published data evaluating asthmatic patients using High Resolution Esophageal Manometry (HREM) and the v.3 Chicago classification. Methods: Single-center, retrospective review of HREM studies from January 1, 2015 to December 31, 2019 performed in asthmatic patients. HREM was performed using a standardized protocol and catheter (36 circumferential sensors spaced 1cm apart; 18 impedance channels O.D. 4.2mm; Sierra Scientific Instruments, Given Imaging). The v.3 Chicago Classification was used for study interpretation. Results: This study included 151 patients (Table 1). Typical GERD symptoms were present in 78 (51.6%) patients; 95 (62.9%) patients had manometric abnormalities. The most common findings were esophagogastric junction outflow obstruction in 35 (23.2%) patients, and IEM in 33 (21.9%) patients (Table 2). Mean values of LES length, LES resting pressure, upper esophageal sphincter resting pressure, and integrated relaxation pressure were within normal limits (Table 3). Ninety (59.6%) patients were using albuterol inhalers, this did not significantly change HREM findings (p >.05) (Table 3). Eighty eight patients also underwent pH-testing (24-hour impedance-pH or 48-hour BRAVO test) with a mean (standard deviation) DeMeester score of 17.72 (26.44). Discussion: This novel study using HREM found multiple manometric abnormalities according to the v.3 Chicago classification among patients with asthma, contrary to prior studies using solid state catheters that showed predominantly a prevalence of IEM. In contrast to prior solid state studies, hypotensive LES was not a common finding. Prospective studies evaluating a larger population should be done to further delineate patterns of manometric abnormalities and their impact on asthma care, and to determine the utility of HREM in this population. Previous findings of albuterol-induced esophageal dysmotility were not confirmed in this study.
Disclosures: Marilia Montenegro indicated no relevant financial relationships. Monia Werlang indicated no relevant financial relationships. Alfred Nelson indicated no relevant financial relationships. Brian Lacy indicated no relevant financial relationships.