Current Trends in Clinical Utility of Esophageal Motility Studies

Abstract

Purpose: To evaluate the utility of esophageal motility studies in clinical practice. Methods: Clinical and manometric data from 200 consecutive subjects referred for esophageal motility study from our gastroenterology practice starting January 2001 though December 2005 were reviewed in this study. Each subject underwent manometric evaluation using water perfused manometry. Motility study was considered to be of 1) high clinical utility if specific clinical entity was identified on manometry resulting in appropriate therapeutic intervention, 2) low clinical utility if specific clinical entity was identified on manometry without a change in therapy and 3) limited clinical utility if motility study was normal. Results: The 200 subjects underwent 206 esophageal motility studies during the study period. Mean age was 42 years (range: 18–87) with 130(65%) being females. Major referral indications included (A) dysphagia (65 of 206, 32%),(B) intractable gastroesophageal reflux (27%), (C) non-cardiac chest pain (NCCP) not relieved by therapeutic trial of PPIs and/or normal pH study (19%), (D) dysphagia associated with NCCP (13%) and (E) preoperative evaluation for fundoplication (9%). Major manometric findings were ineffective motility disorder; IMD (62 of 206 studies, 30%), diffuse esophageal spasm; DES (23%), achalasia (12%), hyperkinetic motility disorder (7%), DES with ineffective motility (4%), scleroderma esophagus (4%) and nutcracker esophagus (2%). In 96(47%) of 206 instances, manometric evaluation was of high clinical utility resulting in appropriate therapeutic intervention. This was significantly more common in subjects with NCCP and/or dysphagia (P < 0.05). Manometric findings of DES and achalasia were associated with high clinical utility (P < 0.05). Manometric evaluation was of low and limited clinical utility in 40% and 13% instances respectively. Motility study was of low clinical utility in subjects presenting with intractable reflux and findings suggestive of IMD (P < 0.05). Conclusion: A) Esophageal motility studies have emerging clinical utility in management of patients with non-cardiac chest pain and absence of reflux allowing a positive diagnosis; B) Manometric studies continue to be of high utility in management of patients with dysphagia as a primary complaint; C) Ineffective motility disorder, a new manometric disorder has a high association with gastroesophageal reflux disease but low clinical utility except when planning antireflux surgery.