Tu1186 The Role of Integrated Relaxation Pressure Assessed by Using High Resolution Manometry in Achalasia Patients

Abstract

Background: Esophageal symptoms are common in the general population, and include dysphagia, heartburn and chest pain. High-resolution manometry (HRM) is often utilized to characterize motility disorders as contributors to these symptoms. Studies using HRM have been largely performed at specialized tertiary medical centers, and thus could be influenced by referral bias. To date, there are no studies evaluating the type and frequency ofmotility abnormalities in patients presenting in a community setting.Methods: A retrospective review of 100 consecutive HRM studies for adult patients was performed at a single, community-based medical center in Rockford, IL from January 2012 through December 2013. The Chicago Classification was applied to characterize motility findings. EGD and esophagram studies performed within 2 months of HRM were reviewed. Results: In this community-based study, 59% of patients who underwent HRM met major manometric criteria for esophageal abnormalities. Achalasia (I,II,III) was the most common major manometric abnormality (n=17), followed by esophagogastric junction (EGJ) outflow obstruction (n=10), and hypercontractile esophagus, including jackhammer (n=7) and nutcracker (n= 1). Weak peristalsis with large defects (n=3) and small defects (n=8) accounted for the most common minor criteria. Patients who underwent HRM most commonly presented with dysphagia (54%), followed by heartburn (25%) and chest pain (16%).Manometric abnormalities were present in 42/58 (72%) presenting with dysphagia, 14/26 (54%) with heartburn, and 7/17 (41%) with chest pain. Dysphagia to liquids, when noted by clinicians, was associated withmanometric abnormalities 72% of the time. In those patients withmanometric abnormalities, findings of abnormal esophagram (radiologist observed tertiary contractions, presbyesophagus, spasm, or dysmotility) were seen in 28/35 (80%) patients (SEN 80%; SPEC 36%; ACC 67%). Abnormal EGD findings (gastroenterologist observed dysmotility and/or spasm, significant retained food, tight LES, or suspected achalasia) were seen in 33/ 54 (61%) patients (SEN 61%; SPEC 65%; ACC 63%). In those HRM(abnormal) patients that received both EGD and esophagram, the presence of concurrent abnormalities in these tests occurred in only 17/35 (49%) patients (SEN 49%; SPEC 71%; ACC 55%).Conclusions: To our knowledge, this is the first community-based study to characterize esophageal symptoms using high-resolution esophageal manometry. Manometric abnormalities were common, seen in nearly 60% of patients, and included achalasia (28% of all abnormalities),