Have Referral Patterns to Esophageal Laboratories Changed Over Time? A Study of Esophageal Manometry in 2008 Compared to 1987

Abstract

Purpose: Compare distribution of specific esophageal motility abnormalities and reason for referral to a tertiary esophageal function laboratory in 2008 compared to twenty years ago. Methods: A retrospective review was conducted of patients referred to our esophageal function laboratory from July 2003 to June 2008 (Group A). The primary symptom for referral was identified. The distribution of motility findings, were compared to a prior study conducted by the senior author in 1987 (Group B). Patients were grouped into 3 categories based on primary symptom; dysphagia, noncardiac chest pain, and other (e.g. globus, cough, heartburn, etc.), the latter of which was not included in the final analysis as this was not reported in 1987. The manometric diagnosis for each patient was classified as Normal, Achalasia, Distal esophageal spasm (DES), hypocontractile motility disorder (Ineffective Esophageal Motility [IEM] and/or low LES pressure) and hypercontractile motility disorder (nutcracker and/or high LES pressure). These results were then compared to the data obtained from a large review published by Katz et al (Annals Int Med, 1987) of 1161 patients with noncardiac chest pain or dysphagia and similar manometric classifications. In 1987, patients with hypocontractile motility disorders were labeled as Nonspecific esophageal motility disorder. By today's criteria, they are sufficiently similar to be so classified. Statistics: Chi-Square test to compare groups A to B. A p-value <0.05 is statistically significant. Results: 1263 studies reviewed; other (N=490), dysphagia and chest pain (see Table).TableConclusion: Reason for referral for esophageal function testing has substantially changed dramatically compared to 1980s. Dysphagia (and other) symptoms predominate over chest pain. There is a significant increase in the number of abnormal studies and distribution of motility abnormalities likely reflective of the change in referral pattern.