Spectrum and Clinical Outcome of Motility Disorders on High-Resolution Esophageal Manometry: A Study From a Tertiary Center on Patients With Dysphagia in Pakistan.

Hareem Rehman,Shahab Abid,Safia Awan,Farheen L Hashmi,Adeel Abid

doi:10.7759/cureus.12088

Abstract

ObjectiveThis study aimed to evaluate the outcome of high-resolution esophageal manometry (HRM) in the diagnosis of esophageal motility disorders in a Pakistani population. It also evaluates the outcomes of management of patients with esophageal dysphagia and no structural abnormality on endoscopy.MethodsThis is a cross-sectional study. Patients with symptoms of dysphagia with normal endoscopy were subjected to esophageal manometry and to barium swallow as a part of routine workup. Esophageal motility disorders diagnosed by HRM were compared to barium swallow findings. A follow-up of these patients was done after a one-year interval to evaluate improvement in their symptoms.ResultsA total of 202 patients underwent HRM. There were abnormal findings in 160 patients (79.2%) with achalasia being the most common diagnosis in 35.6% of the total patients. Out of 72 patients diagnosed to have achalasia on HRM, only 46 (32.6%) had similar findings on barium esophagram and this difference is statistically significant, p < 0.001). Among achalasia patients, laparoscopic surgery was performed in 22 (30.5%) patients with 59% patients reporting a good to excellent improvement (>50%) in their symptoms, balloon dilatations were done in 47 (65.27%) patients with a good to excellent improvement in symptoms in 55% patients. Only three patients (5.5%) were given botulinum toxin injections, and two of them had an improvement of >50% in their symptoms. Patients with motility disorders other than achalasia were treated with a combination of proton pump inhibitors (PPIs), calcium channel blockers and selective serotonin reuptake inhibitors (SSRIs).ConclusionAchalasia was the most common esophageal motility disorder in our population. HRM can diagnose significantly more patients with achalasia compared to barium swallow. Likewise, HRM was helpful in detecting other esophageal motility disorders and planning their management.

Highlights

Esophageal dysphagia refers to a difficulty or an abnormality in swallowing food
Laparoscopic surgery was performed in 22 (30.5%) patients with 59% patients reporting a good to excellent improvement (>50%) in their symptoms, balloon dilatations were done in 47 (65.27%) patients with a good to excellent improvement in symptoms in 55% patients
Patients with motility disorders other than achalasia were treated with a combination of proton pump inhibitors (PPIs), calcium channel blockers and selective serotonin reuptake inhibitors (SSRIs)

Summary

Introduction

Dysphagia could be with solids, liquids or both, and it could be progressive or intermittent. It is an important alarm symptom and warrants urgent exclusion of an organic cause via esophageal endoscopy. Dysphagia could be both structural and non-structural. The most prevalent obstructive etiologies leading to esophageal dysphagia are esophageal cancer, peptic strictures and eosinophilic esophagitis [1]. In non-obstructive dysphagia there is usually an absence of any endoscopic or radiologic evidence of a lesion that may lead to an obstruction of a bolus [2], and the symptoms are usually secondary to a motor dysfunction. The major esophageal motor disorders are achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and absent peristalsis [1]

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