2864 Utility of HRM for Improving Diagnosis and Detection of Esophageal Disorders in a Community Clinic

Abstract

INTRODUCTION: High resolution manometry (HRM) has improved the ability to diagnosis esophageal motility disorders. HRM has the potential to provide diagnostic clarity to patients who suffer from dysphagia, gastroesophageal reflux disease, unexplained chest pain, and other non-specific symptoms. The purpose of this study is to explore the diagnostic yield of HRM in classifying esophageal dysmotility, specifically in a community clinic setting rather than the tertiary care center. High diagnostic accuracy better serves patients. Ultimately, community-based HRM prevents overload at large hospitals and improves access to care for patients. METHODS: We reviewed motility studies performed for the past 18 months at a satellite office built to serve the community. We reviewed the indications and diagnostic yield of HRM. RESULTS: From the cohort of 90 patients, the most common indication was esophageal dysphagia (45.5%). Refractory heartburn made up 32.3% of indications; unexplained chest pain made up 12.2%. Preoperative and postoperative assessments made up 7.7% and 2.2%, respectively. 3 patients were unable to finish the study. 87 were able to complete it. Diagnosis was based on the Chicago Classification version 3.0. Of those who completed the study, 44.8% were classified as normal; 29.8% of cases were EGJ outflow obstruction; 6.8% of cases classified as achalasia; distal spasm was not found in any patients; 3.4% of patients classified as hypercontractile esophagus; 4.6% of cases had absent contractility; 8% had ineffective motility; 1.1% had fragmented peristalsis; post-Nissen assessment was done for 1 patient. CONCLUSION: In our study population, HRM had a high diagnostic yield with its ability to identify esophageal dysmotility by narrowing down the pathogenesis of symptoms like dysphagia, heartburn, and chest pain.. For most patients in this cohort, HRM was well-tolerated. With careful patient selection, HRM has a high diagnostic yield. Because of the clinic location, we were able to assist patients in the rural community and minimize delay in care delivery. Furthermore, community-based HRM has the potential to reduce patient load at larger hospitals. By providing this resource in the community, providers in small-scale clinics improve patient access to care. Gyawali CP, Roman S, Bredenoord AJ, et al. Classification of esophageal motor findings in gastroesophageal reflux disease: Conclusions from an international consensus group. Neurogastroenterol Motil. 2017;29:e13104.