Sa1362 Differences in Esophageal Motility Including Esophageal Peristaltic Transitional Zone Between Patients With Globus Sensation With and Without GERD

Abstract

Background & Aims: High-resolution manometry (HRM) capable of pressure monitoring from the pharynx to the stomach together with pressure topography plotting represents an unquestionable evolution in esophageal manometry. HRM is useful in localizing and characterizing the transitional zone (TZ) that exists between the proximal and distal esophageal contractile segments. Although far less common than distal peristaltic or lower esophageal sphincter abnormalities, some studies suggested that TZ defects might be related to dysphagia. Globus sensation is a common symptom and gastroesophageal reflux disease (GERD) has been considered to be one of the important causes, although its pathogenesis is poorly understood. The aim of this study was to investigate differences in esophageal motility including TZ between patients with globus sensation related and unrelated to GERD. Methods: From September 2007 through March 2011, 128 consecutive patients (56 men, 72 women; mean age 53.2 years) who had globus sensation and/or heartburn occurring at least several times per week were recruited. After blood tests, ultrasonography, laryngoscope and endoscopy, 4 patients were excluded from the study because of organic disease. The remaining 124 patients underwent HRM. All patients completed a self-administered 7point Likert scale questionnaire about upper gastrointestinal symptoms before undergoing diagnostic tests. The clinical diagnosis of GERD was made when the Frequency Scale for Symptoms of GERD score was 8 points or higher. Results: Patients were divided into 3 groups: globus sensation with GERD (Group A) (26 men, 40 women; mean age 54.2 years), GERD only (Group B) (18 men, 4 women; mean age 51.3 years) and globus sensation only (Group C) (14 men, 14 women; mean age 54.9 years). As to the esophageal motility, the ratio of normal peristalsis in Group A was significantly lower than the Group C (65.2±4.8 % in Group A vs. 80.8±5.1% in Group C, P< 0.05). On the other hand, temporal prolongation (0.9±0.2 s in Group A vs. 2.6±0.2 s in Group C, P< 0.05) and spatial elongation of TZ (1.5±0.2 cm in Group A vs. 4.3±0.3 cm in Group C, P< 0.05) was significantly larger in Group C compared to those in Group A. Conclusions: This study showed that globus sensation related to GERD was associated with esophageal body dysfunction, while globus sensation unrelated to GERD was associated with coordination failure in TZ.