Masato Hoshino, MD, Abhishek Sundaram, MBBS MPH, Arpad Juhasz, MD, Tommy H Lee, MD, Sumeet K Mittal, MD. Department of Surgery, Creighton University Medical Center, Omaha, Nebraska.
Introduction: Introduction of High resolution impedance manometry (HRIM) has provided a new avenue to assess esophageal function. The objective of this study was to compare HRIM findings in patients with and without dysphagia.
Methods: Patients who underwent HRIM at a single center between 7/1/2008 and 3/31/2010 formed the study population, from which patients with achalasia, a non-relaxing lower esophageal sphincter, esophageal stricture, a large hiatal hernia (>5 cm) and a history of previous foregut surgery were excluded. Individual wave tracings from HRIM were evaluated to determine each swallow as an effective or non-effecitve swallow based on wave progression and liquid/visoucs bolus transits. The Chi-square test was used to compare categorical variables. T-test and Mann-Whitney tests were used to compare continuous variables. We sequentially ran different univariate analysis for different percentages of complete liquid bolus transit waves, complete viscous bolus transit waves and percentage of absent or hypocontractile waves. For instance we compared patients with ≤10% complete liquid bolus transit waves with >10% complete liquid bolus transit waves, for the incidence of dysphagia. This was performed to determine if there was any difference in the incidence of dysphagia between the groups. We sequentially ran different multivariate logistic regression models, in which all the patient variables remained constant except for the percentage of hypocontractile or absent waves. This was performed to determine the percentage of hypocontractile or absent waves which were predictive for dysphagia.
Results: 113 patients satisfied the inclusion and exclusion criteria. Of these, 38 patients (34%) were male and 75 patients (66%) were female. The median age for the study population was 53 years. Of the 113 study patients, 40 patients complained of dysphagia, while 73 patients did not complain of dysphagia. The two groups were similar in terms of age and other co-morbid conditions. Evaluation of HRIM tracings revealed that the percentage of complete liquid bolus transit in patients with dysphagia (median – 90%) was not different (p = 0.338) from patients without dysphagia (median – 90%). Neither was there a difference (p = 0.330) in percentage of complete viscous bolus transit waves between patients with dysphagia (median – 80%) and without dysphagia (median – 70%). Univariate analysis revealed that ≥60% absent or hyopcontractile waves (p=0.039) were distinguishing features for patients with dysphagia. Logistic regression analysis revealed that ≥50% hypocontractile or absent waves (p=0.007) was a predictor for dysphagia.
Conclusion: ≥50% hypocontractile or absent waves on HRIM are distinguishing features for dysphagia. This could be due to the fact that these patients have an intrinsic motility disorder.
Program Number: P279