Evaluation of Esophageal Motor Dysfunction in Patients with End-stage Lung Disease by Applying the Chicago Classification

Abstract

Introduction: Gastroesophageal reflux disease (GERD) has been implicated in the progression of pulmonary fibrosis and post-transplant bronchiolitis obliterans. Esophageal dysmotility can predispose to GERD. The aim of our study was to evaluate the prevalence of esophageal motility disorders in a group of patients presenting for lung transplant evaluation at our institution. We applied the most recent Chicago Classification 3.0 (CC 3.0) to this cohort. Methods: All patients who presented to our institution for the lung transplant evaluation from September 2012 - September 2015, and had a high-resolution manometry (HRM) as part of their workup, were reviewed. All patients underwent HRM evaluation using solid-state HRM catheter (Sierra scientific instruments) with 36 pressure channels, located 1 cm apart. After an acclimation period of 5 minutes, 10 swallows, each with 5 ml water, were performed. HRM parameters were noted and used to determine CC 3.0. Findings from our cohort were compared to the already published normative data. Results: Eighteen patients (180 swallows) were included in our analysis. Mean age was 55 years (range 18-77); 61% of the patients were male; one patient had chronic obstructive pulmonary disease (COPD) and 17 patients had interstitial lung disease (ILD). Analysis of all 180 swallows showed: 35% failed, 13.3% weak and 51.7% normal. Median lower esophageal pressure (LESP) was also low in our cohort (table 1). When CC 3.0 was applied to the 10 representative swallows for each patient, less than half (44.5%) of them had normal HRM findings (table 2). The frequency of abnormal diagnoses was as follows: achalasia (5.5%); EGJ outflow obstruction (5.5%); absent contractility (16.7%) and ineffective esophageal motility (27.8%). 50% (5/10) of all the patients with esophageal motility disorder were completely asymptomatic clinically. Conclusion: Using the CC 3.0, the majority of patients with end-stage lung disease awaiting lung transplantation fulfill criteria for a motility disorder (55.5%). Most had ineffective esophageal motility or absent contractility. LESP and IRP were also low compared to normative data. Given these common findings, the impact of esophageal dysmotility predisposing, or contributing to reflux related lung injury, requires further evaluation.Table 1: Manometric parameters of all 180 swallowsTable 2: Frequency of HRM diagnoses