- Email: [email protected]
Correlation Between the Computer Generated High-resolution Esophageal Manometry Reports and Human Interpretation in the Diagnosis of Esophageal Motility Disorders
We hope to add further results to this study by contacting patients for whom reliable follow up documentation is lacking. Overall, though, we posit PD is a durable non-surgical approach to the treatment of achalasia.
Sa1685 DISRUPTION OF RESTING BRAIN FUNCTIONAL CONNECTIVITY IN UNILATERAL HEMISPHERIC STROKE IS A MAJOR CONTRIBUTOR TO THE DEVELOPMENT OF DYSPHAGIA Arash Babaei, Gang Chen, Ann Helms, Shi-Jiang Li, Reza Shaker
AGA Abstracts
Sa1684
Background: Clinically relevant dysphagia develops in nearly half of the patients affected by unilateral hemispheric stroke. Considering unharmed central pattern generator in the brainstem and the absence of a dedicated swallow center identified in the cortex, the reason for this presentation is not quite understood. We hypothesized that disturbances of functional connectivity among the distributed network of regions that are involved in swallowing contribute to the development of dysphagia. Aim: To characterize and compare the resting functional connectivity (rFC) alterations of previously reported cortical swallowing network (CSN) in unilateral hemispheric stroke patients with and without dysphagia, and correlate the identified rFC metrics with objective fluoroscopic swallowing deficits. Method: Twentyfive adult first-ever unilateral hemispheric stroke patients were studied. All patients underwent dedicated fMRI and videofluoroscopic swallow study (VFSS) 3-10 days after the onset of stroke irrespective of dysphagia status. Three patients were excluded from the analysis due to excessive motion during fMRI. Six core regions of the previously identified cortical swallowing network (CSN) on either hemisphere served as seed regions: rolandic operculum sensory motor, premotor inferior parietal lobule, insula and prefrontal operculum. Pearson product-moment correlation coefficient between CSN seed regions was determined. We also determined the penetration-aspiration score (PAS) for each patient. Nonparametric methods and linear regression analysis were used to identify significant rFC predictors of dysphagia. Results: Baseline characteristics of the included patients divided by dysphagia status are shown in Table 1. Gender, Rankin score, NIH storke scale, laterality or lobar distribution of the ischemic lesion, grey or white matter involvement, or therapeutic intervention was not a predictor of dysphagia. Among rFC metrics, connectivity between ipsilateral rolandic operculum, ipsilateral and contralateral middle cingulate regions (iMC and cMC) were significant predictors of dysphagia (p<0.05). Furthermore as shown in Figure 1, impairment of connectivity between these regions inversely and significantly correlated with PAS. Contralesional intra-hemispheric rFC was not associated with dysphagia. Conclusions: Disruptive effects of stroke on brain connectivity is a major contributor to the development of dysphagia. Functional connectivity between Rolandic operculum and middle cingulate is associated with compromised airway protective mechanisms in unilateral hemispheric stroke patients. These findings may impact prognostic classification of stroke patients and have clinical implication for their subsequent nutritional management. Table-1 Patient characteristics of first-ever unilateral hemispheric stroke patients by dysphagia
CORRELATION BETWEEN THE COMPUTER GENERATED HIGHRESOLUTION ESOPHAGEAL MANOMETRY REPORTS AND HUMAN INTERPRETATION IN THE DIAGNOSIS OF ESOPHAGEAL MOTILITY DISORDERS Fouad Otaki, Amindra S. Arora, Magnus Halland Background: Esophageal high resolution impedance manometry (HRIM) studies are commonly performed in patients with suspected esophageal motility disorders or GERD. Current software used to analyze such studies includes computer algorithms, which generate a diagnosis based on automatic interpretation of multiple swallows. The algorithms are based on progressive iterations of guidelines based on expert consensus. Current clinical practice is for meticulous analysis of each of the 10 swallows by a gastroenterologist to generate a diagnosis. In addition, the human interpreter can incorporate information including symptoms, results from upper endoscopy, barium esophagography and other esophageal function testing. Contrastingly, the computer generated algorithm exclusively relies on data from the HRIM. In our clinical experience we often observe examples of discordance. The aim of this study is to retrospectively assess the correlation between the computer generated high resolution esophageal manometry report and the human interpretation of the same study. Methods: Retrospective review of computer generated reports from 50 consecutive HRIM studies performed at Mayo Clinic and compare these with human interpretation of the study as documented in the electronic medical record. We collected demographic and clinical features to determine predictors of disagreement. For the purpose of this study we assumed the human interpretation as the gold-standard test. Results: Median age amongst patients was 57 (IQR: 48-68), 64% were women, while median BMI was 25.42 (IQR: 22.4-30.5). On evaluation of medication list, 70%, 24%, 8%, 34%, 7% of subjects were on proton pump inhibitors, antihistamine, tricyclic antidepressents, selective serotonin inhibitors and opiates respectively. Endoscopic, demographic, medical, and manometric parameter distribution in subjects having and lacking agreement in human vs patient computer generated manometric diagnosis are listed in Table 1. An overview of human and computer diagnostic findings are listed in Table 2. Overall, there was moderate agreement (44%, κ=0.44, moderate, 95%CI 0.289-0.598) between the computer and human generated diagnoses. However, for the most important manometric diagnosis which is achalasia, the computer alorightm only identfied 30% of cases. Discussion: HRIM has revolutionized the diagnosis and management of upper gastrointestinal motility abnormalities. Concerningly, for the the most important esophageal motor disorder, achalasia, the computer generated report shows remarkably poor performance. There continues to be a need for human interpretation despite improvement in algorithmic software diagnosis. Table 1: Demographic of manometric diagnosis (human and computer generated)
Table 2: Overview of manometric diagnosis (human and computer generated)
Figure-1 Functional connectivity as correlated with outcome of penetration-aspiration scale (PAS)
AGA Abstracts
S-332
Sa1685 DISRUPTION OF RESTING BRAIN FUNCTIONAL CONNECTIVITY IN UNILATERAL HEMISPHERIC STROKE IS A MAJOR CONTRIBUTOR TO THE DEVELOPMENT OF DYSPHAGIA Arash Babaei, Gang Chen, Ann Helms, Shi-Jiang Li, Reza Shaker
AGA Abstracts
Sa1684
Background: Clinically relevant dysphagia develops in nearly half of the patients affected by unilateral hemispheric stroke. Considering unharmed central pattern generator in the brainstem and the absence of a dedicated swallow center identified in the cortex, the reason for this presentation is not quite understood. We hypothesized that disturbances of functional connectivity among the distributed network of regions that are involved in swallowing contribute to the development of dysphagia. Aim: To characterize and compare the resting functional connectivity (rFC) alterations of previously reported cortical swallowing network (CSN) in unilateral hemispheric stroke patients with and without dysphagia, and correlate the identified rFC metrics with objective fluoroscopic swallowing deficits. Method: Twentyfive adult first-ever unilateral hemispheric stroke patients were studied. All patients underwent dedicated fMRI and videofluoroscopic swallow study (VFSS) 3-10 days after the onset of stroke irrespective of dysphagia status. Three patients were excluded from the analysis due to excessive motion during fMRI. Six core regions of the previously identified cortical swallowing network (CSN) on either hemisphere served as seed regions: rolandic operculum sensory motor, premotor inferior parietal lobule, insula and prefrontal operculum. Pearson product-moment correlation coefficient between CSN seed regions was determined. We also determined the penetration-aspiration score (PAS) for each patient. Nonparametric methods and linear regression analysis were used to identify significant rFC predictors of dysphagia. Results: Baseline characteristics of the included patients divided by dysphagia status are shown in Table 1. Gender, Rankin score, NIH storke scale, laterality or lobar distribution of the ischemic lesion, grey or white matter involvement, or therapeutic intervention was not a predictor of dysphagia. Among rFC metrics, connectivity between ipsilateral rolandic operculum, ipsilateral and contralateral middle cingulate regions (iMC and cMC) were significant predictors of dysphagia (p<0.05). Furthermore as shown in Figure 1, impairment of connectivity between these regions inversely and significantly correlated with PAS. Contralesional intra-hemispheric rFC was not associated with dysphagia. Conclusions: Disruptive effects of stroke on brain connectivity is a major contributor to the development of dysphagia. Functional connectivity between Rolandic operculum and middle cingulate is associated with compromised airway protective mechanisms in unilateral hemispheric stroke patients. These findings may impact prognostic classification of stroke patients and have clinical implication for their subsequent nutritional management. Table-1 Patient characteristics of first-ever unilateral hemispheric stroke patients by dysphagia
CORRELATION BETWEEN THE COMPUTER GENERATED HIGHRESOLUTION ESOPHAGEAL MANOMETRY REPORTS AND HUMAN INTERPRETATION IN THE DIAGNOSIS OF ESOPHAGEAL MOTILITY DISORDERS Fouad Otaki, Amindra S. Arora, Magnus Halland Background: Esophageal high resolution impedance manometry (HRIM) studies are commonly performed in patients with suspected esophageal motility disorders or GERD. Current software used to analyze such studies includes computer algorithms, which generate a diagnosis based on automatic interpretation of multiple swallows. The algorithms are based on progressive iterations of guidelines based on expert consensus. Current clinical practice is for meticulous analysis of each of the 10 swallows by a gastroenterologist to generate a diagnosis. In addition, the human interpreter can incorporate information including symptoms, results from upper endoscopy, barium esophagography and other esophageal function testing. Contrastingly, the computer generated algorithm exclusively relies on data from the HRIM. In our clinical experience we often observe examples of discordance. The aim of this study is to retrospectively assess the correlation between the computer generated high resolution esophageal manometry report and the human interpretation of the same study. Methods: Retrospective review of computer generated reports from 50 consecutive HRIM studies performed at Mayo Clinic and compare these with human interpretation of the study as documented in the electronic medical record. We collected demographic and clinical features to determine predictors of disagreement. For the purpose of this study we assumed the human interpretation as the gold-standard test. Results: Median age amongst patients was 57 (IQR: 48-68), 64% were women, while median BMI was 25.42 (IQR: 22.4-30.5). On evaluation of medication list, 70%, 24%, 8%, 34%, 7% of subjects were on proton pump inhibitors, antihistamine, tricyclic antidepressents, selective serotonin inhibitors and opiates respectively. Endoscopic, demographic, medical, and manometric parameter distribution in subjects having and lacking agreement in human vs patient computer generated manometric diagnosis are listed in Table 1. An overview of human and computer diagnostic findings are listed in Table 2. Overall, there was moderate agreement (44%, κ=0.44, moderate, 95%CI 0.289-0.598) between the computer and human generated diagnoses. However, for the most important manometric diagnosis which is achalasia, the computer alorightm only identfied 30% of cases. Discussion: HRIM has revolutionized the diagnosis and management of upper gastrointestinal motility abnormalities. Concerningly, for the the most important esophageal motor disorder, achalasia, the computer generated report shows remarkably poor performance. There continues to be a need for human interpretation despite improvement in algorithmic software diagnosis. Table 1: Demographic of manometric diagnosis (human and computer generated)
Table 2: Overview of manometric diagnosis (human and computer generated)
Figure-1 Functional connectivity as correlated with outcome of penetration-aspiration scale (PAS)
AGA Abstracts
S-332