584 An Optimal Dysphagia-Sensitive Algorithm for Assessing Deglutitive Intrabolus Pressure Using Esophageal High-Resolution Manometry

Abstract

esophageal motility (IEM), 9 with nutcracker esophagus (NE) and 1 with diffuse esophageal spasm (DES). Abnormal manometry in VS was demonstrated in 31 patients (67.4%, 21 IEM, 9 NE, 1 DES). Abnormal transit in LS and VS was demonstrated in 14 (25.9 %) and 18 (33.3%), respectively. The manometric and transit abnormalities were more common in patients with dysphagia (78.5% vs. 21.4%, p=0.04) and in patients with posture instability gait disturbance assessed by UPDRS (p=0.02). Abnormal esophageal function was not correlated to age or Hoehn & Yahr stage. Repetitive deglutition during single swallow was observed in 143 of 540 (26.5%) swallows (mean 1.4±0.4/LS, 1.4±0.5/VS). Repetitive deglutition was significantly correlated with failed peristalsis and incomplete bolus transit (p<0.0001). Abnormal inhibition of motor activity in the oesophageal body during MRS was observed in 30 out of 49 (61.2%) patients; 26 with incomplete inhibition (repetitive contraction), and 4 with failed peristalsis. Abnormal MRS response correlated with abnormal manometry (p=0.043). Conclusion: Repetitive deglutition with abnormal inhibition of motor activity in the oesophageal body is frequently observed in patients with early PD. MRS provides further evidence of selective involvement of either the brain stem or the esophageal myenteric plexus in the early PD.