Penn State University Milton S. Hershey Medical Center Hershey, PA, United States
Alyssa Tuan, MPH1, Nauroz Syed, MD1, Ron Panganiban, MD1, Roland Y. Lee, MD2, Shannon Dalessio, MA1, Ann Ouyang, MD1 1Penn State University Milton S. Hershey Medical Center, Hershey, PA; 2Penn State University Milton S. Hershey Medical Center and College of Medicine, Hershey, PA
Introduction: High-resolution manometry (HRM) is the primary method to evaluate esophageal motility; however, little is known about the stability of disordered peristalsis over time. Ineffective esophageal motility (IEM) was defined as ineffective contractions following ≥ 50% swallows in the Chicago Classification v3.0 (CCv3.0); the updated CCv4.0 requires > 70%. We aim to study patients who received an IEM diagnosis and had at least two HRM studies over time to analyze the stability of disordered peristalsis.
Methods: With IRB approval, records of 183 adults diagnosed with IEM on HRM based on CCv3.0 from 2011 to 2019 were reviewed for HRM studies performed before the IEM diagnosis and up to 3 years afterward. Normal peristalsis is defined as > 50% normal contractions. Indication for manometry, clinical conditions, and manometric data were extracted. Data are presented as means with standard deviation (mean±SD) or range.
Results: Twenty-eight patients had more than one HRM study, some prior to the diagnosis of IEM. Frequencies of initial HRM diagnoses were: IEM CCv3.0 but not CCv4.0 (CCv3.0) (n=6), IEM CCv4.0 (n=10), normal peristalsis (n=9), and absent contractility (n=3). Two of 6 patients diagnosed with IEM CCv3.0 maintained this diagnosis compared to 7 of 10 patients with IEM CCv4.0. Three patients with IEM CCv3.0 and 6 with IEM CCv4.0 had prior normal peristalsis. The initial mean esophageal body findings of patients with normal peristalsis who later converted to IEM CCv3.0 were: 91 ± 10% normal peristalsis; 0% weak, 9 ± 10% failed, & 9 ± 10% ineffective contractions; distal contractile integral (DCI)=1630 ± 1251. Initial findings for patients who converted to IEM CCv4.0 were: 81 ± 16% normal peristalsis; 8 ± 13% weak, 13 ± 12% failed, & 21 ± 14% ineffective contractions; DCI=1582 ± 1127. The most prevalent indication for follow-up HRM studies was dysphagia. Patients with normal peristalsis who converted to IEM typically had an initial HRM indication of dysphagia and GERD. Four of 6 patients who converted from normal peristalsis to IEM CCv4.0 had dysphagia as their initial indication for HRM.
Discussion: More patients diagnosed with IEM CCv4.0 maintained this diagnosis over time compared to patients diagnosed with IEM CCv3.0. Manometries with normal peristalsis followed by a CCv4.0 IEM diagnosis had higher mean percentages of weak, failed, and ineffective swallows compared to those with CCv3.0 on second study. This study adds to our knowledge of the stability of an IEM diagnosis over time.
Figure: Frequency of initial and follow-up high-resolution manometry (HRM) diagnoses, and the mean between-study time interval in months including range
Alyssa Tuan indicated no relevant financial relationships.
Nauroz Syed indicated no relevant financial relationships.
Ron Panganiban indicated no relevant financial relationships.
Roland Lee indicated no relevant financial relationships.
Shannon Dalessio indicated no relevant financial relationships.
Ann Ouyang indicated no relevant financial relationships.
Alyssa Tuan, MPH1, Nauroz Syed, MD1, Ron Panganiban, MD1, Roland Y. Lee, MD2, Shannon Dalessio, MA1, Ann Ouyang, MD1. P1377 - Stability of Manometric Diagnoses Among Patients Diagnosed With Ineffective Esophageal Motility, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.