Spectrum of Non-obstructive Dysphagia on High-Resolution Manometry

Abstract

Introduction: Patients with dysphagia were investigated with high resolution manometry (HRM) to exclude the diagnosis of achalasia. Methods: Seventy-seven patients were enrolled over a period extending from June 2014 to May 2015. Fifty (65%) were male. Their age range was 22 to 79 years. According to the age they were divided in three groups i.e. Group 1 were 22 to 41 year; Group 2 were 42 to 61 years and group 3 were 62 to 79 years, respectively. Patients with functional EGJ obstruction were characterized by impaired EGJ relaxation and intact peristalsis greater than 15 mm Hg according to Chicago Classification criteria. Patients' age and gender were compared with HRM finding of integrated relaxation pressure (IRP) at 4 seconds. Results: Seventy (91%) had dysphagia and 7 (9%) heart burn. On EGD 75(97%) had a normal esophagus examination while 2(3%) had hiatus hernia. Among consecutive high-resolution manometry studies, 12(15%) were normal, 15(20%) had distal esophageal spasm, 17(22%) had achalasia and 33(43%) with esophagogastric junction (EGJ) outflow obstruction. IRP at 4 seconds was less than 15mm Hg.s.cm in group 1in 17 out of 18 (94%); group 2 in 16 out of 46 (35%) and group 3 in 8 out of 13 (61%), respectively (P). Conclusion: Functional EGJ obstruction in our patients was characterized by dysphagia. It was largely present in the middle age population and did not demonstrate gender distribution.