P1372 - High-Resolution Manometry and the Improvement of the Community Diagnosis of Achalasia

Samuel O. Slone, MD¹, Ambuj Kumar, MD², Joel Richter, MD^1
1University of South Florida, Tampa, FL; ²University of South Florida Morsani College of Medicine, Tampa, FL

Introduction: Although uncommon, GI literature on achalasia has expanded exponentially with high resolution manometry (HRM) and improved diagnostic criteria with Chicago classification. The test is widely available but concerns raised about adequate training in HRM. Also, we know little about priority of HRM in testing algorithm when achalasia is suspected compared to EGD/barium esophagram (BE) in community or delays in diagnosis from inappropriate test selection.

Methods: Key question addressed was accuracy of community diagnosis of achalasia among patients referred to Swallowing Center (SWC). Groups designated a priori: I) Achalasia suspected and SWC confirmed; II) Achalasia suspected but SWC did not confirm; and III) Achalasia found in SWC evaluation, not suspected in community. Consecutive patients with suspected achalasia evaluated at our institution between 2016-20 were eligible. Demographic and clinical testing information obtained via EMR. Positive community test required words “suspected achalasia or achalasia” and diagnostic accuracy compared to SWC evaluation.

Results: 103 patients (55 men, average age 66 years) met inclusion criteria. Primary complaint: dysphagia solids/liquids (56.3%), dysphagia solids (35.9%), dysphagia liquids (1%) and no dysphagia (6.8%). Figure summarizes classification: Group I 56%, Group II 22% and Group III 22%. Diagnoses for last group: EGJOO (15 patients), jackhammer (1), ineffective esophageal motility (1), GERD (3), peptic stricture (1) and functional dysphagia (1). 81 patients had final SWC diagnosis of achalasia. EGD done in 98% with dilations in 61 patients, multiple dilations in 26. EGD accuracy only 37%. BE done in 54% with accuracy of 40% despite reports having descriptive terms like “dilated, tertiary contractions or distal stricture.” HRM done in 42%,. Diagnostic accuracy 65% - community diagnosis correct for achalasia in 22/32 (69%) (Table) and 5 false positives..

Discussion: In the community 1) despite classic symptoms, diagnosis of achalasia only correctly made in 56% of patients, 2) HRM is the most accurate test at 65% though is not frequently used 3) EGD is overused and usually misses diagnosis of achalasia, even in patients with repeat dilations, and 4) BE often incorrectly interpreted although suggestive descriptive terms used. Community diagnosis of achalasia is improving but HRM is not being used early in the testing algorithm.




Disclosures:


Samuel O. Slone, MD¹, Ambuj Kumar, MD², Joel Richter, MD¹. P1372 - High-Resolution Manometry and the Improvement of the Community Diagnosis of Achalasia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.