Tu1973 Esophageal Dysmotility Is Highly Prevalent in Persons With SCI Compared to Able-Bodied Controls As Identified With High-Resolution Manometry and the Use of the Chicago Classification

Abstract

BACKGROUND: A paucity of information exists with regard to the effects of spinal cord injury (SCI) on esophageal motility. Due to the complete or partial loss of sensory innervation to the esophagus, a symptom-based diagnosis of esophageal dysmotility is often delayed, if even appreciated, although some degree of occult impaired motility is likely to be present. AIM: To compare the incidence and to determine the differences in esophageal motility parameters between persons with chronic SCI and able-bodied controls by the use of high resolution manometry (HRM) and the Chicago Classification (CC). METHODS: HRM was performed in 39 asymptomatic individuals: 14 able-bodied controls (AB) and 25 SCI subjects (level of injury between C5-T10). A catheter that contained multiple pressure sensors which were arranged at 360 degrees was introduced into the esophagi of subjects at a distance that permitted both the upper (UES) and lower (LES) esophageal sphincters to be captured. After a baseline period to assess basal pressures, each subject was asked to perform 10 wet swallows of 5 ml boluses of isotonic saline while esophageal pressure and impedance were recorded. Esophageal topography parameters (EPT) were calculated using analysis software and two independent reviewers classified the manometric findings according to the CC. RESULTS: There were no significant differences in gender, age or BMI between AB and SCI groups. Eighty-four % (21 out of 25) of the SCI subjects studied were diagnosed with at least one motility abnormality: 12% with Type II achalasia, 4% with Type III achalasia, 20% with EGJ outflow obstruction, 4%with a hypercontractile esophagus, and 48%with peristaltic abnormalities (i.e., weak peristalsis with small or large defects or frequent failed peristalsis). In contrast, only 7% (1 out of 14) of the AB subjects was diagnosed with any type of motility disorder (hypercontractile esophagus). CONCLUSION: Despite the lack of subjective complaints or clinical awareness, esophageal dysmotility appears to be relatively prevalent in the SCI population. The use of new and improved esophageal manometry techniques and a more stringent classification system permitted the presence of wide array of motility disorders in almost all subjects with SCI to be identified, including achalasia that went previously undiagnosed in 4 subjects. Future work will be required to clarify the clinical