Slow esophageal propagation velocity: association with dysphagia for solids

Abstract

Spastic disorders of the esophagus, associated with rapid esophageal propagation velocity, are classically associated with dysphagia and/or chest pain. The aim of this study was to characterize patients with slow esophageal propagation velocity (SPV) on high-resolution esophageal manometry (HRM). A review of patients undergoing HRM was conducted during 1-year study period. Patients with achalasia, aperistalsis, and diffuse esophageal spasm were excluded. Patients with contractile front velocity (CFV) ≤ 2.3 cm s(-1) were defined as having SPV, whereas normal propagation velocity (NPV) was defined as ≥ 2.6 cm s(-1). A composite isobaric contour of all swallows for each patient was generated to determine composite distal contraction latency (cDL). A total of 650 HRMs were reviewed and 552 met inclusion criteria. 173 patients had SPV and 339 had NPV. There was a greater female predominance in the SPV group compared with NPV (75.7%vs 66.4%, P = 0.03). Patients in the SPV group reported more dysphagia for solids (66.3%vs 53.3%; P = 0.004) and nausea (68.6%vs 59.0%; P = 0.04) than NPV group. Dysphagia for solids was the only symptom significantly associated with SPV group (OR = 2.21, CI = 1.21-4.02; P = .01). There was a negative correlation between CFV and cDL, r = -0.494, P < 0.001. Patients with SPV have a higher prevalence of dysphagia for solids and nausea when compared with NPV. Dysphagia for solids was the only symptom significantly associated with SPV group. Thus, abnormal esophageal propagation velocity (both slow and rapid) is associated with dysphagia.