Tu1196 Gastrointestinal (GI) Symptoms in Patients With Dysphagia Referred for High Resolution Manometry: Presence of Lower GI Symptoms Is a Negative Predictor for Achalasia

Abstract

Background: High Resolutions Manometry (HRM) is the gold standard for the categorisation of motility disorders of the oesophagus, with achalasia as one of the most distinct manometric conditions. We aimed to compare the gastrointestinal symptom pattern and intensity in patients referred for HRM with and without a final diagnosis of achalasia utilising the recently developed SAGIS (Structured Assessment of Gastrointestinal Symptoms) instrument. Methods: Data from 50 consecutive patients referred for HRM for dysphagia were included in this study, mean age 56 years, range 17-84, 28 female. All patients had a negative upper GI endoscopy and other tests required to exclude structural abnormalities. Gastrointestinal symptoms were assessed prior to the HRM utilising the SAGIS questionnaire. Results: Based upon the Chicago Classification, 9 out of the 50 patients were diagnosed as having achalasia (6 males, 3 females). Overall, neither dysphagia nor the cumulated upper GI symptom score or scores for retrosternal discomfort were different for patients with or without achalasia (table 1). In contrast, patients with non-specific motor abnormalities had increased scores for IBS-type lower gut symptoms. Conclusions: Utilising the recently developed SAGIS instrument, patients with achalasia are not different from dysphagia patients with no/unspecific motor abnormalities of the oesophagus with regard to upper gastrointestinal symptoms. In particular, there are no differences in relation to the dysphagia or the retrosternal discomfort score. In contrast, patients with no/unspecific motor abnormalities, scored much higher for lower gastrointestinal symptoms than achalasia patients. In addition, IBS-type symptoms such as urgency to defecate are significantly increased. In patients with dysphagia, the presence of lower gut symptoms is a negative predictor for achalasia. Table 1