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Esophageal Symptoms are Common and Related to other Functional Gastrointestinal Disorders (FGIDS) in a Western Population
with GERD were included in re-analyses, GERD was a significant predictor for chest pain and heartburn (OR 1.939 and 1.525), but not globus and dysphagia. The prevalence of symptom constellations consistent with Rome IV esophageal diagnoses was 1% for globus, 3.2% for functional dysphagia, 0.7% for reflux hypersensitivity, 0.8% for functional chest pain, and 1.1% for functional heartburn. There was a significant difference in symptoms consistent with any functional esophageal disorder between USA 7.0%, UK 4.3% and Canada 5.9% (p=0.003). Conclusions Esophageal symptoms compatible with a functional esophageal disorder are common in the Western population. Age and presence of other GI and nonGI symptoms are associated with reporting esophageal symptoms. Factors independently associated with presence of esophageal symptoms compatible with a functional esophageal disorder
AGA Abstracts
Table 1: shows demographics and presenting symptoms in patients with Achalasia II, Achalasia III and DES.
DES : Distal Esophageal Spasm; F : Female; SD : Standard Deviation; BMI : Body Mass Index
Sa1679 LOSS OF PERISTALTIC RESERVE IS THE MOST FREQUENT ESOPHAGEAL MOTILITY ABNORMALITY SEEN IN PATIENTS WITH PARAESOPHAGEAL HERNIA Albert M. Ding, Shanglei Liu, Ran B. Luo, Garth R. Jacobsen, Santiago Horgan, David Kunkel BACKGROUND&AIM Paraesophageal hernias remain a relatively uncommon diagnosis, but often result in surgical repair. Preoperative evaluation typically includes esophageal manometry, pH analysis, and anatomical imaging through CT or barium swallow. However, there remains little information on the relationship between esophageal motility findings and de-novo paraesophageal hernias. We aimed to characterize the pre-operative manometry findings in this unexplored group of patients and also assess peristaltic reserve using multiple rapid swallows (MRS). METHODS We retrospectively evaluated adult patients who undergoing paraesophageal hernia repair at our tertiary care center. We analyzed pre-operative esophageal high-resolution manometry (HRM) studies that included assessment of peristaltic reserve using MRS. A total of 45 patients (37 women, age 35-89 years old) over a three year period were included. HRM findings were analyzed according to the Chicago Classification version 3.0 (CC) to provide an esophageal motility diagnosis. Peristaltic reserve was assessed by evaluating the response to MRS for the presence of contraction and for augmentation, defined as the distal contractile integral after MRS greater than the median distal contractile integral after 10 supine swallows. RESULTS The most common CC diagnosis was normal motility in 32/45 patients (71%). Abnormal CC findings included esophagogastric junction (EGJ) outflow obstruction in 8/45 (18%) patients followed by ineffective esophageal motility 4/45 patients (9%). On MRS, absence of contraction was seen in 12/45 (27%) patients and absence of peristaltic augmentation in 40/45 (89%) patients, indicating poor peristaltic reserve. CONCLUSION Based on our large cohort, loss of peristaltic reserve as measured by MRS is the most common esophageal motility abnormality seen among patients with unrepaired paraesophageal hernia. A similar frequency of loss of peristaltic reserve has been reported in patients with scleroderma (Carlson et al, 2016). These findings suggest that longstanding paraesophageal hernia may be damaging to the neuromuscular integrity of the esophagus, which argues in favor of early surgical repair. Future prospective studies are necessary to validate these findings as well as explore the effects of surgical repair on esophageal dysmotility. Variables with a p-value of 0.1 or less in univariate analysis were entered into a multivariate analysis (logistic regression) in order to identify factors independently associated with esophageal symptoms (up to 33 variables).
Sa1680 ESOPHAGEAL SYMPTOMS ARE COMMON AND RELATED TO OTHER FUNCTIONAL GASTROINTESTINAL DISORDERS (FGIDS) IN A WESTERN POPULATION Axel Josefsson, Olafur S. Palsson, Magnus Simren, Ami D. Sperber, Hans Törnblom, William E. Whitehead
Sa1681 FUNCTIONAL AND ANATOMICAL MORPHOLOGY OF THE CRURAL DIAPHRAGM IN HEALTHY SUBJECTS REVEALED BY HIGH DEFINITION LES PRESSURE PROFILE AND CT-SCAN IMAGING Ali Zifan, Dushyant Kumar, Melissa M. Ledgerwood-Lee, Erika Ruppert, Garry Ghahremani, Ravinder K. Mittal
Introduction The prevalence and frequency of esophageal symptoms suggestive of a functional esophageal disorder according to the Rome IV criteria are unknown. This study aimed to describe the general population prevalence and risk factors for esophageal symptoms compatible with functional esophageal disorders. Methods Data from an online survey of 6300 individuals age ≥18 years in the United States, United Kingdom and Canada (2100 in each country) including the Rome IV diagnostic questionnaire for adults and demographic questions was used. Quota-based sampling ensured equal proportions of sex, age groups, and education distributions across countries. Prevalence and frequency of esophageal symptoms in the past 3 months and putative functional esophageal disorders were retrieved from the Rome IV questionnaire. Symptoms were considered present if they occurred at least weekly for dysphagia, chest pain, and globus, and at least twice weekly for heart burn. Variables with a p≤0.1 in univariate analyses were entered into a multivariate analysis (logistic regression) to identify factors independently related to esophageal symptoms. As endoscopy and pH measurement are parts of the clinical diagnosis of esophageal disorders in the Rome IV criteria, we only describe esophageal symptoms compatible with functional esophageal disorders. Somatization was assessed with the Patient Health Questionnaire (PHQ)-12. Results Data from 5177 participants (47.8% female; mean age 46.7 (range 18-92) years; 1645 US, 1734 UK, 1798 Canada) were retained for analysis after 369 inconsistent responders and 754 previously diagnosed with gastroesophageal reflux disease (GERD) were excluded. Esophageal symptom prevalence was: feeling of a lump or something stuck in the throat (globus) 8.1% (n=420), heartburn 6.5% (n=334), dysphagia 4.5% (n=233) and chest pain 5.2% (n=269). Independent predictors for increased risk of esophageal symptoms included younger age, symptoms consistent with other FGIDs, using medications for gastrointestinal symptoms, somatization, cannabis use, and certain foods (see table 1). When individuals
AGA Abstracts
Background and Aims: The smooth muscles of LES and skeletal muscles of crural diaphragm are two major sphincter mechanisms at the lower end of esophagus (EGJ). The end-expiratory EGJ pressure is due to LES and the increase in pressure with inspiration is related to crural diaphragm contraction. Precise anatomical relationship between LES and CD and number of questions remain unanswered with regards to CD pressure profile, 1) whether similar to LES is it also circumferentially and axially asymmetric, and 2) where is it located in the EGJ pressure profile and its anatomical relationship with the esophageal hiatus formed by the CD. Methods: A high definition pressure catheter with 96 transducers, (12 rings, 7.5mm apart, over 9cm length of catheter, 8 transducers in each ring(Medtronics)) was used to record the EGJ pressure in 10 healthy subjects (mean age: 44.1±14.4 years). A 0.5mm diameter metal ball was taped on the catheter, adjacent to transducer #1 of the first ring. The EGJ Pressure was recorded at end-expiration denoted by TE, and during inspirations (CD contractions), 1) tidal inspiration (TI) and 2) forced maximum inspiration (FI). Prior to the removal of the catheter, a CT scan (from mid thorax to mid-abdomen) was obtained to localize the axial and circumferential location of the metal ball on the catheter in 5 subjects. Results: the metal ball was clearly visualized on CT scan in all subjects and its circumferential orientation in subjects varied between 5-7Oclock. Based on the positon of transducer #1, circumferential location of all 96 sensors on the catheter was determined. The end-expiration pressure profile (LES) is longer and descends for a greater length on the right side (less curvature of the stomach) than left. Peak LES pressure is located in the left posterior direction. Contraction of CD (TI & FI) increased EGJ pressure proportionally.
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AGA Abstracts
Table 1: shows demographics and presenting symptoms in patients with Achalasia II, Achalasia III and DES.
DES : Distal Esophageal Spasm; F : Female; SD : Standard Deviation; BMI : Body Mass Index
Sa1679 LOSS OF PERISTALTIC RESERVE IS THE MOST FREQUENT ESOPHAGEAL MOTILITY ABNORMALITY SEEN IN PATIENTS WITH PARAESOPHAGEAL HERNIA Albert M. Ding, Shanglei Liu, Ran B. Luo, Garth R. Jacobsen, Santiago Horgan, David Kunkel BACKGROUND&AIM Paraesophageal hernias remain a relatively uncommon diagnosis, but often result in surgical repair. Preoperative evaluation typically includes esophageal manometry, pH analysis, and anatomical imaging through CT or barium swallow. However, there remains little information on the relationship between esophageal motility findings and de-novo paraesophageal hernias. We aimed to characterize the pre-operative manometry findings in this unexplored group of patients and also assess peristaltic reserve using multiple rapid swallows (MRS). METHODS We retrospectively evaluated adult patients who undergoing paraesophageal hernia repair at our tertiary care center. We analyzed pre-operative esophageal high-resolution manometry (HRM) studies that included assessment of peristaltic reserve using MRS. A total of 45 patients (37 women, age 35-89 years old) over a three year period were included. HRM findings were analyzed according to the Chicago Classification version 3.0 (CC) to provide an esophageal motility diagnosis. Peristaltic reserve was assessed by evaluating the response to MRS for the presence of contraction and for augmentation, defined as the distal contractile integral after MRS greater than the median distal contractile integral after 10 supine swallows. RESULTS The most common CC diagnosis was normal motility in 32/45 patients (71%). Abnormal CC findings included esophagogastric junction (EGJ) outflow obstruction in 8/45 (18%) patients followed by ineffective esophageal motility 4/45 patients (9%). On MRS, absence of contraction was seen in 12/45 (27%) patients and absence of peristaltic augmentation in 40/45 (89%) patients, indicating poor peristaltic reserve. CONCLUSION Based on our large cohort, loss of peristaltic reserve as measured by MRS is the most common esophageal motility abnormality seen among patients with unrepaired paraesophageal hernia. A similar frequency of loss of peristaltic reserve has been reported in patients with scleroderma (Carlson et al, 2016). These findings suggest that longstanding paraesophageal hernia may be damaging to the neuromuscular integrity of the esophagus, which argues in favor of early surgical repair. Future prospective studies are necessary to validate these findings as well as explore the effects of surgical repair on esophageal dysmotility. Variables with a p-value of 0.1 or less in univariate analysis were entered into a multivariate analysis (logistic regression) in order to identify factors independently associated with esophageal symptoms (up to 33 variables).
Sa1680 ESOPHAGEAL SYMPTOMS ARE COMMON AND RELATED TO OTHER FUNCTIONAL GASTROINTESTINAL DISORDERS (FGIDS) IN A WESTERN POPULATION Axel Josefsson, Olafur S. Palsson, Magnus Simren, Ami D. Sperber, Hans Törnblom, William E. Whitehead
Sa1681 FUNCTIONAL AND ANATOMICAL MORPHOLOGY OF THE CRURAL DIAPHRAGM IN HEALTHY SUBJECTS REVEALED BY HIGH DEFINITION LES PRESSURE PROFILE AND CT-SCAN IMAGING Ali Zifan, Dushyant Kumar, Melissa M. Ledgerwood-Lee, Erika Ruppert, Garry Ghahremani, Ravinder K. Mittal
Introduction The prevalence and frequency of esophageal symptoms suggestive of a functional esophageal disorder according to the Rome IV criteria are unknown. This study aimed to describe the general population prevalence and risk factors for esophageal symptoms compatible with functional esophageal disorders. Methods Data from an online survey of 6300 individuals age ≥18 years in the United States, United Kingdom and Canada (2100 in each country) including the Rome IV diagnostic questionnaire for adults and demographic questions was used. Quota-based sampling ensured equal proportions of sex, age groups, and education distributions across countries. Prevalence and frequency of esophageal symptoms in the past 3 months and putative functional esophageal disorders were retrieved from the Rome IV questionnaire. Symptoms were considered present if they occurred at least weekly for dysphagia, chest pain, and globus, and at least twice weekly for heart burn. Variables with a p≤0.1 in univariate analyses were entered into a multivariate analysis (logistic regression) to identify factors independently related to esophageal symptoms. As endoscopy and pH measurement are parts of the clinical diagnosis of esophageal disorders in the Rome IV criteria, we only describe esophageal symptoms compatible with functional esophageal disorders. Somatization was assessed with the Patient Health Questionnaire (PHQ)-12. Results Data from 5177 participants (47.8% female; mean age 46.7 (range 18-92) years; 1645 US, 1734 UK, 1798 Canada) were retained for analysis after 369 inconsistent responders and 754 previously diagnosed with gastroesophageal reflux disease (GERD) were excluded. Esophageal symptom prevalence was: feeling of a lump or something stuck in the throat (globus) 8.1% (n=420), heartburn 6.5% (n=334), dysphagia 4.5% (n=233) and chest pain 5.2% (n=269). Independent predictors for increased risk of esophageal symptoms included younger age, symptoms consistent with other FGIDs, using medications for gastrointestinal symptoms, somatization, cannabis use, and certain foods (see table 1). When individuals
AGA Abstracts
Background and Aims: The smooth muscles of LES and skeletal muscles of crural diaphragm are two major sphincter mechanisms at the lower end of esophagus (EGJ). The end-expiratory EGJ pressure is due to LES and the increase in pressure with inspiration is related to crural diaphragm contraction. Precise anatomical relationship between LES and CD and number of questions remain unanswered with regards to CD pressure profile, 1) whether similar to LES is it also circumferentially and axially asymmetric, and 2) where is it located in the EGJ pressure profile and its anatomical relationship with the esophageal hiatus formed by the CD. Methods: A high definition pressure catheter with 96 transducers, (12 rings, 7.5mm apart, over 9cm length of catheter, 8 transducers in each ring(Medtronics)) was used to record the EGJ pressure in 10 healthy subjects (mean age: 44.1±14.4 years). A 0.5mm diameter metal ball was taped on the catheter, adjacent to transducer #1 of the first ring. The EGJ Pressure was recorded at end-expiration denoted by TE, and during inspirations (CD contractions), 1) tidal inspiration (TI) and 2) forced maximum inspiration (FI). Prior to the removal of the catheter, a CT scan (from mid thorax to mid-abdomen) was obtained to localize the axial and circumferential location of the metal ball on the catheter in 5 subjects. Results: the metal ball was clearly visualized on CT scan in all subjects and its circumferential orientation in subjects varied between 5-7Oclock. Based on the positon of transducer #1, circumferential location of all 96 sensors on the catheter was determined. The end-expiration pressure profile (LES) is longer and descends for a greater length on the right side (less curvature of the stomach) than left. Peak LES pressure is located in the left posterior direction. Contraction of CD (TI & FI) increased EGJ pressure proportionally.
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