The Contribution of High-Resolution versus Conventional Esophageal Manometry to the Assessment of Esophageal Motor Disorders in Patients With Non-Cardiac Chest Pain (NCCP)

Abstract

Introduction: NCCP is defined as recurring, angina-like, retrosternal chest pain of non-cardiac origin. It has been estimated that up to 30% of the non-GERD related NCCP patients demonstrate an esophageal motor disorder using conventional manometry (CM). Thus, the aim of the study was to determine if high resolution esophageal manometry (HREM), which has become the standard of care, improved the diagnosis of esophageal motor disorders, as compared with CM, in patients with NCCP. Methods: We evaluated 300 consecutive non-GERD related NCCP patients who underwent either HREM or CM. A total of 150 patients had CM and the other 150 patients HREM. The Chicago 3 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of patients undergoing HREM and CM, respectively. Results: In both HREM and CM groups, a normal esophageal motility study was the most frequent finding (47% vs. 36%, respectively). In patients who underwent CM, the most commonly demonstrated esophageal motility disorder was hypotensive lower esophageal sphincter. Hypotensive LES was a significantly more common finding in patients undergoing CM versus HREM (27.3% vs. 4.7%, p<0.001). Other less common motility disorders seen in the CM group were nonspecific esophageal motility disorders (NEMD) (12%), nutcracker esophagus (9.3%), ineffective esophageal motility (IEM) (6.7%), achalasia (2.7%), distal esophageal spasm (DES) (5.3%), and absent contractility (0.67%). In general, hypertensive motility disorders, like DES and nutcracker esophagus, were less common than hypotensive motility disorders (15% vs. 35%, p=0.9) in NCCP patients. There was no significant difference in the number of hypertensive or hypotensive motility disorders diagnosed with CM versus those diagnosed with HREM. In the HREM group, IEM was the most commonly diagnosed motility abnormality. The likelihood of finding an IEM was significantly more common in the HREM group as compared with the CM group (25% vs. 7%, p<0.001). Other motility abnormalities that were less commonly diagnosed with HREM included: achalasia (7.3%), esophagogastric junction outflow obstruction (4%), absent contractility (4%), jackhammer/nutcracker esophagus (3.3%), DES (2.7%) and NEMD (1.3%). Conclusion: HREM did not improve the percentage and type of esophageal motor disorders diagnosed in NCCP patients as compared with CM. This is likely due to limitations of Chicago 3 classification. Normal esophageal motility remains the most common finding.