- Email: [email protected]
Su1079 Esophageal Motility Disorders, Response to Multiple Rapid Swallows, and Bolus Transit Abnormalities in Patients With Non-Obstructive Dysphagia
Su1079
AGA Abstracts
Esophageal Motility Disorders, Response to Multiple Rapid Swallows, and Bolus Transit Abnormalities in Patients With Non-Obstructive Dysphagia Laya Nasrollah, Mohanad Al-Qaisi, Michael Crowell, George E. Burdick, David E. Fleischer, Francisco C. Ramirez, Marcelo F. Vela Introduction: Non-obstructive dysphagia (NOD) is defined by difficulty swallowing solids or liquids in the absence esophageal structural obstructive lesion on esophagram and esophagogastroduodenoscopy (EGD). There is limited data regarding the rate of esophageal motility disorders on high resolution manometry (HRM) as defined by Chicago Classification version 3.0 (CCv3.0) in patients with NOD. Furthermore, little is known about response to multiple rapid swallows (MRS) or bolus transit abnormalities by impedance in patients with NOD and normal HRM. Our aim was to describe the prevalence of motility disorders by CCv3.0, abnormal response to MRS, and bolus transit abnormalities in patients with NOD. Methods: Retrospective analysis of adult patients without prior esophageal surgery who underwent esophagram, EGD, and HRM for evaluation of dysphagia from 06/2014 to 11/2015. Demographics and results of EGD and esophagram were ascertained by chart review. HRM results obtained from our motility database. HRM was performed with a solid-state catheter with 36 circumferential pressure sensors 1-cm apart; ten 5-ml liquid swallows given, followed by MRS sequence, tracings analyzed with Manoview software (Covidien, Duluth, GA). Lower esophageal sphincter (LES) pressure, LES integrated relaxation pressure, distal contractile integral, and distal latency were determined and CCv3.0 algorithm was applied. For MRS evaluation, presence or absence of inhibitory response during swallows, and peristaltic contraction after swallows was determined. Bolus transit was analyzed for studies performed with HRM catheter that also incorporates 18 impedance channels. Bolus transit was considered abnormal when incomplete (retained bolus in any segment) in ‡30% swallows. Results: 135 patients underwent esophagram, endoscopy, and HRM for evaluation of esophageal dysphagia. 56 (41%) had mechanical obstruction on esophagram or EGD. Demographics and HRM findings for the 79 patients with NOD shown in table 1, a motility disorder was found in 44 of them (56%). Of 35 patients with NOD and normal HRM, bolus transit was abnormal in 11 (31%). MRS assessment was performed in 32 of the 35 patients with NOD and normal HRM; it was abnormal in 15 (47%): abnormal inhibition phase only in 3, abnormal post MRS contraction only in 7, abnormal inhibition and post MRS contraction in 5. (Figure 1). Conclusion: Over 50% of patients with NOD have an esophageal motility disorder that may explain their dysphagia. In patients with NOD and normal HRM, bolus transit is abnormal in one third, whereas response to MRS is abnormal in 47%. The role of abnormal bolus transit and abnormal response to MRS in patients with NOD deserves further study. Table1. Demographics and HRM Findings in 79 Patients with NOD
Su1078 Optimizing High-Resolution Impedance Manometry: A Prospective Study to Validate Normal Values for Novel Viscous and Super-Viscous Substrates Erik B. Person, Donald O. Castell, Erik von Rosenvinge, Jean-Pierre Raufman, Guofeng Xie BACKGROUND: Previous studies revealed that changing body position and using viscous or solid boluses alters manometry patterns and may enhance detection of esophago-gastric junction outflow obstruction (EGJOO), an important new manometric diagnosis with increasing incidence. Yet, these analyses were limited by lack of standardized substrate and absence of impedance data. We addressed this gap in knowledge by performing high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions in normal volunteers . HYPOTHESIS: Compared to supine saline swallows, changes in body position and bolus viscosity will enhance detection of changes in bolus transit and peristaltic pressures, increasing sensitivity for detection of EGJOO. METHODS: Power calculation based on integrated relaxation pressure predicted that enrolling 30 volunteers would detect a difference of 2.57 mmHg between two means. Viscous and super-viscous substrates were made using 100 g saline heated to boiling with 5 or 10 g of "Thick-It" food thickener added. Each was assayed with a rotational viscometer to quantify viscosity in millipascal-seconds (mPa-s) at room temperature. Nine volunteers underwent HRiM (Sandhill Sci). Each received ten saline swallows, followed by five 5-g swallows and five 10-g swallows, all in 5-ml increments in supine position. Subjects then received five 5-g and five 10-g swallows while upright. Integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), peristaltic breaks (PBs), and bolus transit were measured. Impedance was analyzed by recovery of tracing to ‡ 50% of baseline at 5, 10, and 15 cm above the lower esophageal sphincter. Mean, SD, 5th, and 95th percentiles were noted. ANOVA was used to compare all metrics by position and substrate. RESULTS: The 5-g substrate measured 5000 mPa-s at 21.6°C and 10-g substrate measured 64,700 mPa-s at 22°C. Nine volunteers (5M, 4F) provided 260 swallows. Mean age was 37.0±9.7 years (range 28.9-59.0), mean BMI was 26.5±4.6 kg/m2 (range 21.8-34.3). Table 1 shows normative data. IRP was lower upright than supine for all substrates (p<0.001-0.01). DL was higher for upright 5-g than supine saline swallows (p<.01). PBs were greater for upright 5-g and 10-g than supine saline swallows (p<.01, p<.001). DCI was not different between groups. Three subjects had oropharyngeal transfer difficulties with 10-g substrate. CONCLUSION: Viscosity and position have a significant effect on the metrics of bolus transit. These preliminary studies provide a framework for an objective method to evaluate swallow function using changes in bolus viscosity and position. Additional volunteers should help confirm the utility of super-viscous substrates, validate normative data, and permit application to the evaluation of patients with non-obstructive dysphagia. Normative High-Resolution Impedance Manometry (HRiM) Parameters For Viscous And Super-Viscous Swallows
Figure 1. Bolus Transit and Response to MRS in patients with NOD and normal HRM.
Su1080 Does High Resolution Endoscopy and 24-hour Multiple Intraluminal Impedance-pH Monitoring can Distinguish Patients With Non-Erosive Reflux Disease From Those With Functional Heartburn? Chuanlian Chu, Quanlin Du, Linlu Zhang, Shumei Wang Background:Non erosive reflux disease (NERD) and functional heartburn (FH) are the heterogeneous diseases of absence of esophagealmucosal erosions/breaks at conventionalendoscopy. The differentiation of these two diseases is essential for the choice of further treatment. Objective:To assess the contribution of esophageal intraluminal impedance and pH (MII-pH) monitoring and high resolution endoscopy (HRE) in identifying white light
AGA Abstracts
S-462
AGA Abstracts
Esophageal Motility Disorders, Response to Multiple Rapid Swallows, and Bolus Transit Abnormalities in Patients With Non-Obstructive Dysphagia Laya Nasrollah, Mohanad Al-Qaisi, Michael Crowell, George E. Burdick, David E. Fleischer, Francisco C. Ramirez, Marcelo F. Vela Introduction: Non-obstructive dysphagia (NOD) is defined by difficulty swallowing solids or liquids in the absence esophageal structural obstructive lesion on esophagram and esophagogastroduodenoscopy (EGD). There is limited data regarding the rate of esophageal motility disorders on high resolution manometry (HRM) as defined by Chicago Classification version 3.0 (CCv3.0) in patients with NOD. Furthermore, little is known about response to multiple rapid swallows (MRS) or bolus transit abnormalities by impedance in patients with NOD and normal HRM. Our aim was to describe the prevalence of motility disorders by CCv3.0, abnormal response to MRS, and bolus transit abnormalities in patients with NOD. Methods: Retrospective analysis of adult patients without prior esophageal surgery who underwent esophagram, EGD, and HRM for evaluation of dysphagia from 06/2014 to 11/2015. Demographics and results of EGD and esophagram were ascertained by chart review. HRM results obtained from our motility database. HRM was performed with a solid-state catheter with 36 circumferential pressure sensors 1-cm apart; ten 5-ml liquid swallows given, followed by MRS sequence, tracings analyzed with Manoview software (Covidien, Duluth, GA). Lower esophageal sphincter (LES) pressure, LES integrated relaxation pressure, distal contractile integral, and distal latency were determined and CCv3.0 algorithm was applied. For MRS evaluation, presence or absence of inhibitory response during swallows, and peristaltic contraction after swallows was determined. Bolus transit was analyzed for studies performed with HRM catheter that also incorporates 18 impedance channels. Bolus transit was considered abnormal when incomplete (retained bolus in any segment) in ‡30% swallows. Results: 135 patients underwent esophagram, endoscopy, and HRM for evaluation of esophageal dysphagia. 56 (41%) had mechanical obstruction on esophagram or EGD. Demographics and HRM findings for the 79 patients with NOD shown in table 1, a motility disorder was found in 44 of them (56%). Of 35 patients with NOD and normal HRM, bolus transit was abnormal in 11 (31%). MRS assessment was performed in 32 of the 35 patients with NOD and normal HRM; it was abnormal in 15 (47%): abnormal inhibition phase only in 3, abnormal post MRS contraction only in 7, abnormal inhibition and post MRS contraction in 5. (Figure 1). Conclusion: Over 50% of patients with NOD have an esophageal motility disorder that may explain their dysphagia. In patients with NOD and normal HRM, bolus transit is abnormal in one third, whereas response to MRS is abnormal in 47%. The role of abnormal bolus transit and abnormal response to MRS in patients with NOD deserves further study. Table1. Demographics and HRM Findings in 79 Patients with NOD
Su1078 Optimizing High-Resolution Impedance Manometry: A Prospective Study to Validate Normal Values for Novel Viscous and Super-Viscous Substrates Erik B. Person, Donald O. Castell, Erik von Rosenvinge, Jean-Pierre Raufman, Guofeng Xie BACKGROUND: Previous studies revealed that changing body position and using viscous or solid boluses alters manometry patterns and may enhance detection of esophago-gastric junction outflow obstruction (EGJOO), an important new manometric diagnosis with increasing incidence. Yet, these analyses were limited by lack of standardized substrate and absence of impedance data. We addressed this gap in knowledge by performing high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions in normal volunteers . HYPOTHESIS: Compared to supine saline swallows, changes in body position and bolus viscosity will enhance detection of changes in bolus transit and peristaltic pressures, increasing sensitivity for detection of EGJOO. METHODS: Power calculation based on integrated relaxation pressure predicted that enrolling 30 volunteers would detect a difference of 2.57 mmHg between two means. Viscous and super-viscous substrates were made using 100 g saline heated to boiling with 5 or 10 g of "Thick-It" food thickener added. Each was assayed with a rotational viscometer to quantify viscosity in millipascal-seconds (mPa-s) at room temperature. Nine volunteers underwent HRiM (Sandhill Sci). Each received ten saline swallows, followed by five 5-g swallows and five 10-g swallows, all in 5-ml increments in supine position. Subjects then received five 5-g and five 10-g swallows while upright. Integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), peristaltic breaks (PBs), and bolus transit were measured. Impedance was analyzed by recovery of tracing to ‡ 50% of baseline at 5, 10, and 15 cm above the lower esophageal sphincter. Mean, SD, 5th, and 95th percentiles were noted. ANOVA was used to compare all metrics by position and substrate. RESULTS: The 5-g substrate measured 5000 mPa-s at 21.6°C and 10-g substrate measured 64,700 mPa-s at 22°C. Nine volunteers (5M, 4F) provided 260 swallows. Mean age was 37.0±9.7 years (range 28.9-59.0), mean BMI was 26.5±4.6 kg/m2 (range 21.8-34.3). Table 1 shows normative data. IRP was lower upright than supine for all substrates (p<0.001-0.01). DL was higher for upright 5-g than supine saline swallows (p<.01). PBs were greater for upright 5-g and 10-g than supine saline swallows (p<.01, p<.001). DCI was not different between groups. Three subjects had oropharyngeal transfer difficulties with 10-g substrate. CONCLUSION: Viscosity and position have a significant effect on the metrics of bolus transit. These preliminary studies provide a framework for an objective method to evaluate swallow function using changes in bolus viscosity and position. Additional volunteers should help confirm the utility of super-viscous substrates, validate normative data, and permit application to the evaluation of patients with non-obstructive dysphagia. Normative High-Resolution Impedance Manometry (HRiM) Parameters For Viscous And Super-Viscous Swallows
Figure 1. Bolus Transit and Response to MRS in patients with NOD and normal HRM.
Su1080 Does High Resolution Endoscopy and 24-hour Multiple Intraluminal Impedance-pH Monitoring can Distinguish Patients With Non-Erosive Reflux Disease From Those With Functional Heartburn? Chuanlian Chu, Quanlin Du, Linlu Zhang, Shumei Wang Background:Non erosive reflux disease (NERD) and functional heartburn (FH) are the heterogeneous diseases of absence of esophagealmucosal erosions/breaks at conventionalendoscopy. The differentiation of these two diseases is essential for the choice of further treatment. Objective:To assess the contribution of esophageal intraluminal impedance and pH (MII-pH) monitoring and high resolution endoscopy (HRE) in identifying white light
AGA Abstracts
S-462