Weak Peristalsis in Esophageal Pressure Topography: Classification and Association With Dysphagia (Am J Gastroenterol 2011;106:349-356)

Abstract

For weak peristalsis, no validated metrics currently exist in high resolution esophageal pressure topography (EPT). This study aimed to define normal values of control subjects, to test for abnormalities of these metrics in a cohort of patients with unexplained nonobstructive dysphagia. High resolution impedance manometry studies were carried out in 16 control subjects to verify EPT features associated with incomplete bolut transit (IBT). The normal range for EPT features associated with IBT was established by scoring each of another 75 control subject's EPT study for the occurrence of features identified from the high resolution impedance manometry findings and EPT simulation. The EPT integrity was compared between control subjects and 113 patients with non-obstructive dysphagia identified from a large clinical series. Large breaks (> 5 cm) in the 20 mmHg isobaric contour were uniformly associated with IBT, and small breaks (2-5 cm) variably associated with IBT. The normal range for isobaric contour breaks was 0%-20% for large (> 5 cm) and 0%-30% for small (2-5 cm) breaks, with both occurring significantly more frequently in dysphagic patients. Failed peristalsis occurred no more frequently in dysphagic patients than in normal subjects. According to the occurrence frequency of breaks in the 20 mmHg isobaric contour, a classification of weak peristalsis adapted to EPT is proposed. Weak peristalsis with large breaks is defined by those occurring with > 20% of swallows and weak peristalsis with small breaks defined by those occurring with > 30% of swallows.