Tu1193 Impaired Bolus Transit of Esophageal Swallows May Play an Important Role in Eliciting Non-Cardiac Chest Pain: A Study Using High-Resolution Impedance Manometry

Abstract

Background/Aims: Although gastroesophageal reflux disease (GERD) has been suggested to be a major etiology of globus, there is still considerable debate about the causative role of GERD in globus patients. We aimed to investigate the new etiology of globus and its mechanism using high-resolution impedance manometry (HRIM). Methods: A total of 57 consecutive patients with globus sensation, who underwent HRIM, impedance-pH monitoring, and upper endoscopy at Samsung Medical Center, Seoul, Korea, between June 2011 and August 2012, were identified. In addition, 9 normal subjects were recruited and included into analysis. The patients were divided according to the presence of GERD and impaired bolus transit (IBT) for analysis. Using HRIM, esophageal peristalsis parameters, esophageal hypomotility markers including intersegmental trough (IST), extended IST, proximal latency (PL), prolonged PL and fragmented or failed sequence, and bolus transit pattern were evaluated. Esophageal motility abnormality was determined according to the Chicago classification. Results: Of the 57 globus patients, 28 (49.1%) were male and the mean age was 52.3 ± 13.0 (SD) years. Thirteen globus patients (22.8%) were diagnosed with GERD and 42 (73.7%) showed IBT. In comparison between globus patients and normal controls, globus patients were older and more likely to have IBT and had higher integrated relaxation pressure and longer peristaltic break and IST than normal controls (P,0.05). However, there were no significant differences between the two groups with regard to sex, body mass index, reflux esophagitis, other peristalsis parameters, motility abnormality, and other hypomotility markers. In comparison between GERD-related and non GERD-related globus groups, no significant differences were identified with regard to age, sex, body mass index, underlying disease, concomitant symptom, peristalsis parameters, motility abnormality, hypomotility markers, and IBT. Regardless of GERD, the majority of globus patients showed IBT: 9 (69.2%) in GERD-related globus group and 33 (75.0%) in non GERD-related globus group (P=0.73). In comparison between IBT and normal bolus transit globus groups, IBT globus group had higher distal contractile integral and contractile front velocity and longer peristaltic break, IST, and PL and was more likely to have motility abnormality and fragmented or failed sequence than normal bolus transit globus group (P,0.05). Although the majority of globus patients (20/21, 95.2%) with motility abnormality showed IBT, a significant portion of globus patients (22/42, 52.4%) with IBT did not have motility abnormality. Conclusion: IBT may be a major etiologic factor in globus patients. Esophageal motility abnormality alone does not explain the IBT enough, suggesting that other mechanisms are involved in determining IBT in globus patients.