Can Dysphagia Be Objectively Characterized Using Multichannel Intraluminal Impedance?

Introduction:
The purpose of this study is to determine if the subjective sensation of dysphagia can be objectively characterized using esophageal function testing.
Dysphagia is one of the most difficult symptoms to diagnose and to treat unless a patient has achalasia. Esophageal function testing (EFT) now combines standard manometry, which measures pressures in the esophagus, with multichannel intraluminal impedance, which measures volume and bolus transit within the esophagus. Thus far, few objective findings for dysphagia have been identified with manometry alone. This case series was designed to further understand dysphagia with impedance.
METHODS AND PROCEDURES
Consecutive patients undergoing EFT’s in the Esophageal Physiology Laboratory between July 2008 and June 2009 were studied prospectively. EFT’s are conducted with 10 liquid and 10 viscous swallows. Patients were asked to determine whether they had the subjective sensation of something being “stuck” in the esophagus (SF) with each swallow. All data were entered into a prospective database. Data regarding patient demographics, presenting symptoms and the EFT findings were also collected. Data were analyzed using Z- test for proportions and P value was calculated.
RESULTS
A total of 2780 swallows were performed in 139 patients (M: F=60:79, average age= 54.3). The manometric diagnoses were normal peristalsis (101), non-specific motility disorder (7), achalasia (12), distal esophageal spasm (3), nutcracker esophagus (7), connective tissue disorder (4) and ineffective esophageal motility (5). Of the 2780 swallows, patients described having a stuck feeling (SF) in 42% of swallows, of which the majority were with the viscous material. Incomplete bolus transit was detected by impedance in 65.8% of swallows, equally divided between liquid and viscous swallows. Patients were then divided into 2 groups, those with a primary complaint of dysphagia (n=65) and those with other complaints (n=74 with heartburn, GERD, hoarseness, asthma, chestpain). The results are shown in Table1. (LS, VS= liquid and viscous swallows respectively)

Table1

Description Dysphagia(n=65,1300 swallows) No dysphagia(n=74,1480 swallows P- value (signi<0.05)
liquid swallows viscous swallows liquid swallows viscous swalllows

P-Value LS

P-Value

VS

No Bolus transit(BT) 283(43%) 310(47%) 160(21%) 162(22%)

LS<0.0001

VS<0.0001

Stuck Feeling(SF) 170(26%) 276(42%) 50(7%) 101(14%)

LS<0.0001

VS<0.0001

SF and no BT(% of BT) 40% 59% 12% 30%

LS<0.0001

VS<0.0001

Patients with a primary complaint of dysphagia sensed a stuck feeling with incomplete bolus transit significantly more than the patients who do not have a primary complaint of dysphagia. Those without dysphagia did not have subjective complaints of a stuck feeling with incomplete bolus transit the majority of the time. Furthermore, those patients with a primary complaint of dysphagia had many more swallows incompletely transmitted compared to the no dysphagia group.

Conclusion: Patients with dysphagia as a primary complaint are more likely to subjectively sense an incomplete bolus transmission with swallows. Therefore, impedance technology may better explain the subjective feeling of dysphagia by objectively showing incomplete bolus transmission. Patients with a primary complaint of dysphagia should be evaluated with combined manometry and impedance


Session: Podium Presentation

Program Number: S077

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