Tu1422 Questioning the Significance of Large and Small Breaks on High Resolution Esophageal Manometry With Liquids and Solids in Patients With Dysphagia

abnormalities in esophageal peristalsis in patients with dysphagia than the conventional protocol with liquid swallows (p 0.02 and 0.03, respectively). (Table) Conclusions: Our data suggest that the esophageal manometry protocol should include RS, SS and SFS in order to improve the diagnostic yield of HRM in patients with non-obstructive dysphagia. HRM Parameters and contraction patterns with LS, RS, SS and SFS

AGA Abstracts

patients, the procedure was aborted due to restlessness and in one patient due to stasis of food. Conclusion Esophageal botox injection for the treatment of esophageal motility disorders is an off-label indication and should not be considered a completely safe treatment option, as at least one lethal complication has occurred. Reported complications following 465 botulinum toxin injections for esophageal motility disorders.

* Fatigue (3x), sore throat (3x), difficulty breathing (2x), acute urinary retention Tu1422 Questioning the Significance of Large and Small Breaks on High Resolution Esophageal Manometry With Liquids and Solids in Patients With Dysphagia Amy R. Welch, Vikram Budhraja, Nikrad Shahnavaz, Ming Wang, Deborah M. Bethards, Ann Ouyang Weak peristalsis is seen in patients (pts) with normal and impaired esophageal transit but is not always associated with symptoms(Sx), raising questions of its clinical relevance. Some suggest that large breaks (LB) but not small breaks(SB) are commonly accompanied by impaired bolus transit(IBT) of liquids, but little data exists for solid swallows. AIMS: Assess the association of LB and SB when swallowing liquids or solids, correlate their presence with clinical Sx using a questionnaire(SQ), and assess the correlation of LB, SB and IBT (using Chicago Criteria 2011). METHODS: Retrospective chart reviews of pts undergoing high resolution esophageal manometry at Hershey from Jan 2013 to Mar 2014. Diagnoses of aperistalsis, achalasia, EGJ outflow obstruction, jackhammer or nutcracker esophagus or spasm were excluded. Statistics: descriptive analysis, Pearson and Kendal tau correlation coefficients. RESULTS: 97 pts were included. Overall, 37.1% had LB with 46.5% having IBT. 60.8% had SB with 29.3% having IBT. 46 pts were referred for dysphagia: 43.4% had LB and 71.7% had SB. 41 pts were referred for GERD: 41.4% had LB and 56.1% had SB. 37 pts underwent HREM with both liquids and solids. Presence of LB or SB with either liquids or solids did not correlate with the Sx of dysphagia either to liquids or solids (univariate analysis). Presence of LB with solids correlated with referral Sx of dysphagia(p= 0.03) but also with referral Sx of GERD(p=0.005). Presence of LB with liquids correlated with presence of LB with solids only in pts with solid dysphagia on SQ(p=0.05). There was good correlation between presence of LB and presence of SB with liquids only in the pts population overall(p=0.01) but not in pts referred for dysphagia or with dysphagia by SQ. Presence of IBT with LB significantly correlates with presence of IBT with SB in all dysphagia groups(p<0.01). There is also excellent correlation between the number of SB and LB with the number of IBT for SB and LB(p<0.0001).There is overlap of Sx of dysphagia and heartburn by SQ in pts referred for dysphagia and GERD. Significant agreement exists between a referral Sx of dysphagia and Sx of liquid, solid or any dysphagia by SQ (Kaplan coefficient; p<0.001). There was correlation of Sx of heartburn(p=0.002) and regurgitation(p= 0.01) but not chest pain and belching with referral Sx of GERD. CONCLUSIONS: Overall, our data suggests that the presence of breaks is not correlated with the symptom of dysphagia, but those patients with more LB are likely to have SB. In addition, those with IBT with LB are likely to have IBT with SB. The number of breaks is associated with the likelihood of IBT with the breaks. The presence of breaks per se does not appear to be a cause of dysphagia. Whether adding solid boluses could add significantly to the diagnostic value of HREM needs further investigation in a larger sample.

Table HRM Parameters and contraction patterns. HV= healthy volunteers, LS, RS, SS and SFS. LS=liquid swallows, RS=rapid swallows, SS=solid swallows, SFS standarized food swallows, LES lower esophageal sphincter, IRP integrated relaxation pressure, DCI distal contractile integral, CFV contractile front velocity, IBP intrabolus pressure, EGJ esophagogastric junction. * HV versus dysphagia p < 0.05, + LS versus RS or SS or SF p< 0.05 Tu1424 Pressure Drift Correction in Prolonged Ambulatory Solid-State HighResolution Manometry Systems Ali Zifan, Cainan Foltz, Melissa M. Ledgerwood, Ravinder K. Mittal Background: Long term ambulatory esophageal high resolution manometry (HRM) can be potentially a valuable technique to study the relationship between esophageal symptoms and abnormal motility. One of the problems in prolonged pressure recordings is pressure drift, the genesis of which can be related to: 1) temperature, 2) sensor deformation caused by mechanical forces, 3) fluid/debris collection on sensors, and 4) unknown. Aims: To determine the patterns of baseline pressure drift in the HRM catheter, manufactured by Unisensor AG (Denmark) and propose an automatic framework to minimize the former, whilst persevering pressure signal fidelity. Experimental Setup: Studies were conducted in-vitro and in-vivo (humans) using Unisensor HRM catheter (36 transducers). For the invitro studies, catheters were placed in a water bath (37°C) for 24 hours, tested four times. For the in-vivo studies, recordings were performed in 5 normal subjects. Catheter was calibrated at room temperature and placed into the esophagus for 24 hours at the end of which recordings were continued after the removal of the catheter from the subject. Methods: For both settings, two methods were tested: 1) immediate extubation pressure (IEP) subtraction and 2) state of the art wavelet denoising and statistical background learning (SBL). In the latter, for each window an estimate of the signal background value was produced using the Expectation Maximization (EM) algorithm. The derived estimates were then linearly regressed in order to track slow and fast baseline changes, and to construct a continuous baseline curve of the time varying pressure baselines for each of the 36 channels in the 24 hour recording. For the in-vivo studies, at least 5 TLESR episodes were chosen for each subject to determine residual relaxation pressure. Results: In the in-vitro studies, different channels drifted by different amounts and drift was logarithmic in nature. The average drift for all transducers was 3.37± 6.08mmHg, reproducible across the 4 days. The greatest drift for any sensor was 10.85±3.07mmHg. Besides the logarithmic drift, an inherent random pressure offset (2.14±0.09mmHg) was also observed. Quantitative analysis was carried out to study the efficacy of both methods (see Table1). The residual pressure during TLESR was close to gastric pressure during the entire recording period using SBL rather than IEP method, especially in the earlier recording hours. Respiration related fluctuation in the esophageal pressure tracing were seen using SBL but not the IEP method (see Fig. 1(i)). Conclusions: Compensation maneuvers using IEP overcorrects pressures in the earlier hours of long HRM recordings (see Fig. 1(b) and (k)). The SBL method is more accurate to reduce the pressure drift, and can be integrated in existing manometry software. Comparison of absolute lower esophageal sphincter pressures for drift correction using immediate extubation pressure subtraction and statistical learning method.

Tu1423 Impact of Rapid Swallows and Solid Swallows With Standardized Food in the Evaluation of the Esophageal Motility With High-Resolution Manometry in Healthy Volunteers and Patients With Dysphagia Monica R. Zavala-Solares, Elisa N. Saleme, Enrique Coss-Adame, Lourdes L. Pinzón Te, Miguel A. Valdovinos Background: Esophageal manometry is conventionally evaluated with 10 liquid swallows of 5 ml each 30 seconds. Recent studies suggest that the inclusion of liquid rapid swallows and solid swallows with bread or marshmallows, detect a major number of motility disorders. Aim: To evaluate esophageal motility with high resolution manometry (HRM) with 4 different protocols: liquid swallows (LS), rapid swallows (RS), solid swallows with bread (SS) and standardized food (SFS) swallows in healthy volunteers (HV) and patients with dysphagia, in a physiologic position for eating. Materials and methods: Healthy volunteers and consecutive patients with non-obstructive dysphagia (except achalasia) underwent to HRM, with a solidstate catheter with 36 pressure sensors and Manoview 2.0 analysis program (Given Imaging, Yoqneam, Israel). In sitting position, 4 different swallow protocols were evaluated: LS: 10 liquid swallows of 5 ml every 30 s; RS:5 swallows of 3 ml every 3 s; SS: 2 cm3 of sliced bread and SFS: 3 cm3 of jam and cheese sandwich. Manometric parameters and diagnosis (according to Chicago Criteria: normal, weak peristalsis/frequent failed peristalsis, Jackhammer esophagus, hypertensive contraction, EGJ outflow obstruction, spasm and rapid contractions) were compared with RS, SS and SSF. Non-parametric statistics and chi2 or Fisher's exact test were used for the comparisons. Results: 22 HV, 7 women, mean age 31 (range 22-55) years old and 22 patients with dysphagia, 7 women, mean age 46 (range 20-76) years old were studied. The results of HRM metrics and manometric diagnoses are depicted in Table. The dysphagia group had symptoms (dysphagia/chest pain) during the SS (p 0.013) and with SFS (p 0.004) compared to HV. SS and SFS identified significantly more

AGA Abstracts

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