2854 High Resolution Esophageal Manometry Findings in Patients With Esophageal Symptoms After Head and Neck Radiation Therapy

Abstract

INTRODUCTION: Head and neck radiation therapy is known to cause esophagitis and esophageal strictures as early and late effects after radiation exposure, respectively. The negative effects of radiation on esophageal motor function have been speculated in case reports but have not been studied in a larger population with high resolution manometry (HRM). The aim of this study was to evaluate HRM findings in patients who received head and neck or mediastinal radiation and presented with esophageal symptoms. METHODS: There were a total of 718 patients who received HRM from 2010 to 2018 at the Michael E. DeBakey VA Medical Center. Patients were excluded if they had undergone esophageal surgery, found to have oro-pharyngeal dysphagia, or if they had a mechanical cause on esophagogastroduodenoscopy of esophageal symptoms. Among the cohort, 14 patients met our inclusion criteria of receiving head and neck or mediastinal radiation prior to HRM. Chicago Classification v3.0 was used for HRM diagnoses. RESULTS: The most common symptom for which HRM was performed was esophageal dysphagia in 8 patients. Regurgitation and chest pain were each reported in 3 patients. Heartburn (n = 2), odynophagia (n = 1), and hoarseness (n = 1) were also reported symptoms. Seven of 14 patients (50.0%) were found to have abnormal findings on HRM (Table 1). Findings included hypotensive lower esophageal sphincter (LES) (n = 2), hypertensive LES (n = 1), hypotensive upper esophageal sphincter (UES) (n = 1), UES stricture (n = 1), spastic achalasia (n = 1), and ineffective esophageal motility (n = 1). There was no difference in HRM findings based on radiation dose received (Figure 1). There was an association towards increased HRM abnormalities with time since last radiation (Figure 2). CONCLUSION: This is one of the largest studies to show the effects of head and neck radiation on esophageal motility using HRM. Fifty percent of patients in this cohort exposed to head and neck radiation had abnormalities on HRM. We have also shown an association towards increased abnormal HRM findings with time, especially greater than five years after radiation exposure. Similar to our study, achalasia and ineffective peristalsis have been reported both early and late after head and neck radiation. Despite reports of esophageal motility complications with increasing doses of radiation, we were unable to demonstrate this. Our findings suggest that patients with esophageal symptoms after radiation exposure should be investigated for esophageal motor dysfunction.