Association of Mayo Dysphagia Questionnaire 30-Day Scores to the Chicago Classification Diagnosis of Weak Peristalsis

Abstract

Introduction: The Chicago classification of esophageal motility helps facilitate the interpretation of high resolution esophageal pressure topography studies. One unique feature of this classification is a hierarchical organization of motor disorders into those never encountered in normal individuals and those that lie outside of statistical norms. The latter group of disorders, including weak peristalsis, has less clear clinical significance and may even be present in normal subjects. The purpose of our study was to evaluate the association between weak peristalsis and the symptom of dysphagia via the Mayo Dysphagia Questionnaire-30 Day (MDQ-30) given the uncertain clinical significance of these peristaltic breaks. Methods: Consecutive patients presenting to our motility lab from May 2013 to March 2014 to receive high resolution esophageal manometry for any indication were asked to complete the MDQ-30, a tool used to reliably evaluate dysphagia symptoms over the last 30 days. A total of 100 patients completed both questionnaire and manometry. Each patient was assigned a dysphagia score based on their response to selected questions involving the symptom of dysphagia. Fisher’s exact test was used to evaluate statistical significance between the dysphagia score and the manometric diagnosis of weak peristalsis, with the level of statistical significance set at a P value of less than .05. Results: 38/100 patients met the Chicago classification definition of weak peristalsis with either large or small breaks. Out of these patients, 55% (21/38) had weak peristalsis with small breaks, 37% (14/38) had weak peristalsis with large breaks, and 8% (3/38) had both small and large peristaltic breaks. Using a cut off dysphagia score of 25 obtained from prior studies using this questionnaire, we found no statistically significant association between the symptom of dysphagia and the finding of weak peristalsis (small, large or mixed breaks) on esophageal manometry (Fisher’s exact test, p-value= 0.27). There was a slightly higher percentage of patients with normal esophageal motility compared to weak peristalsis (43% vs 39% respectively, p=0.79) who had “dysphagia” as the indication for undergoing manometry. Conclusion: Weak peristalsis is a common diagnosis encountered during the evaluation of patients receiving esophageal manometry. Our goal was to attempt to clarify the clinical significance of this diagnosis. When comparing MDQ-30 dysphagia scores to a diagnosis of weak peristalsis on high resolution esophageal pressure topography, we find no statistically significant association between weak peristalsis (large and/or small peristaltic breaks) and the symptom of dysphagia.