Tu1988 Distal Esophageal Spasm According to the Chicago Classification: Is Timing Everything?

Abstract

Introduction: According to the Chicago classification of esophageal motility disorders, distal esophageal spasm (DES) is defined as a normal mean integral relaxation pressure (IRP) in combination with premature esophageal contractions (distal (DL) 9.0 cm/s) but with a normal DL. In the Chicago classification this poorly characterized abnormality is labelled rapid contractions with normal latency (RCNL). Aim: To investigate the differences between patients with DES and patients with RCNL. Methods: We retrospectively evaluated the clinical characteristics and high-resolution manometric recordings of patients with a normal IRP and simultaneous esophageal contractions with and without a short DL. The results of the barium esophagogram were also taken into account (absence or presence of tertiary contractions). Results: Since February 2012, 19 patients were identified. Of these, 8 fulfilled the Chicago criteria for DES (DES), including a short DL. The remaining 11 patients showed simultaneous contractions in the distal esophagus but with DL >4.5 s (RCNL). DES patients were younger than RCNL patients (59 ± 4 versus 72 ± 3 years, P <0.05). There was no difference in gender distribution between DES and RCNL. Symptoms of dysphagia and retrosternal pain occurred similarly in both groups. Weight loss and tertiary contractions on barium esophagogram tended to be more frequent in DES patients, although this was not statistically significant. There was no difference between the groups in the distal contractile integral (DCI, 2006 ± 466 mmHg.cm.s in RCNL versus 2549 ± 955 mmHg.cm.s in DES), nor in the CFV (15.6 ± 3.5 cm/s in RCNL versus 18.5 ± 3.7 cm/s in DES) . Lower esophageal sphincter resting pressure was not different in DES versus RCNL. However, the IRP was significantly higher in DES compared to RCNL (11.7 ± 0.7 mmHg vs 7.6 ± 1.2 mmHg, P <0.05), albeit still within the normal range. Conclusion: Patients with DES (short DL) and patients with RCNL (normal DL) have similar symptom profiles. DES patients are older and tend to show weight loss and an abnormal barium esophagogram more often than RCNL patients. These data suggest that RCNL represents a subgroup of patients within the spastic contraction spectrum, with less severe manifestations in an earlier phase of the disease process compared to DES with premature contractions.