Sa1324 Diagnosis of Esophageal Achalasia Using Water-Perfused Catheter High Resolution Manometry

Abstract

Background The latest iteration of the Chicago classification segregates esophageal motility disorders into disorders with impaired esophago-gastric junction (EGJ) relaxation (achalasia, EGJ outflow obstruction), motility disorders not observed in normal subjects (absent peristalsis, distal esophageal spasm, hypercontractile esophagus) and statistically defined peristaltic abnormalities (weak/frequent failed peristalsis, nutcracker, rapid peristalsis). However the clinical relevance of the latter group remains to be determined. Our aim was to evaluate dysphagia severity according to this classification. Patients and methodsWithin a randomized study to evaluate the impact of esophageal high resolution manometry (HRM) in patients with dysphagia, we selected all patients with a manometric diagnosis according to the Chicago classification. Seventy-five patients (30 men, mean age 54 years, range 18-88) included between March 2011 and November 2012 were thus analyzed. Sydney swallow questionnaire (1) was administrated to patients: this questionnaire included 15 questions on dysphagia characteristics and 2 questions on quality of life (QOL). The maximal score was 1700 and was lower than 200 in healthy controls in the validation study (1). Scores were expressed as median (range) and compared between groups using Kruskal Wallis or Mann-Whitney test. Results Esophageal motility disorders are presented in the table. Among patients with impaired EGJ relaxation, 19 presented achalasia and 6 EGJ outflow obstruction. Sydney score was significantly different between the 3 groups (p ,0.01) as well as QOL (p,0.01). Patients with impaired EGJ relaxation had higher Sydney score than those with normal motility (p,0.01) and those with weak/frequent failed peristalsis (p=0.07). QOL was also more altered in patients with impaired EGJ relaxation compared to those with normal motility (p,0.01) and those with weak/frequent failed peristalsis (p=0.06). Finally Sydney score and QOL were similar between normal and weak/frequent failed peristalsis (p=0.36 and p=0.22 respectively). Sydney score was normal (,200) in 10 patients (6 with normal esophageal motility, 4 with weak or frequent failed peristalsis). Conclusion Our study confirmed that dysphagia was more severe in patients with achalasia than in those with normal or weak/frequent failed peristalsis. Dysphagia severity and impact on quality of life were similar in patients with weak/frequent failed peristalsis and normal esophageal motility. These results suggest that the Chicago classification might accurately segregate esophageal motility disorders according to the symptom severity. The impact of weak/ frequent failed peristalsis on quality of life might be modest if it exits. Reference: (1) Wallace et al. Gastroenterology 2000