TY - JOUR
T1 - High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals
AU - Rengarajan, Arvind
AU - Rogers, Benjamin D.
AU - Wong, Zhiqin
AU - Tolone, Salvatore
AU - Sifrim, Daniel
AU - Serra, Jordi
AU - Savarino, Edoardo
AU - Roman, Sabine
AU - Remes-Troche, Jose M.
AU - Ramos, Rosa
AU - Perez de la Serna, Julio
AU - Pauwels, Ans
AU - Leguizamo, Ana Maria
AU - Lee, Yeong Yeh
AU - Kawamura, Osamu
AU - Hayat, Jamal
AU - Hani, Albis
AU - Gonlachanvit, Sutep
AU - Cisternas, Daniel
AU - Carlson, Dustin
AU - Bor, Serhat
AU - Bhatia, Shobna
AU - Abrahao, Luiz
AU - Pandolfino, John
AU - Gyawali, C. Prakash
N1 - Funding Information:
Conflicts of Interest These authors disclose the following DAC has served as a teacher and as a consultant and has a licensing agreement with Medtronic. Jose M. Remes-Troche has served as a consultant for Medtronic, Takeda, and Asofarma; and received lecture fees Medtronic, Takeda, Asofarma, Janssen, and Sanfer. Sabine Roman has served as a consultant for Medtronic and received research support from Diversatek Healthcare and Medtronic. Edoardo Savarino has received lecture fees from Medtronic, Takeda, Janssen, MSD, AbbVie, and Malesci; and served as a consultant for Medtronic, Takeda, Janssen, MSD, Reckitt Benckiser, Sofar, Unifarco, SILA, and Oftagest. Jordi Serra received research grants or acted as consulter/speaker for AB-biotics, Allergan, Bayer, Cassen-Recordati, Norgine, Reckitt Benckiser, Salvat, and Zespri; Daniel Sifrim has received research grants from Reckitt Benckiser UK, Jinshan Technology China, and Alfa Sigma Italy. John Pandolfino has served as a consultant for Medtronic, Diversatek, Torax, Ironwood, Takeda, and AstraZeneca; received research funding from Impleo; and owns stock options in Crospon. C. Prakash Gyawali has served as a consultant for Medtronic, Diversatek, Isothrive, Ironwood, and Quintiles. The remaining authors disclose no conflicts.
Publisher Copyright:
© 2022
PY - 2022/3
Y1 - 2022/3
N2 - Objective: High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems. Design: Manometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders. Results: Of 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions. Conclusions: Motor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.
AB - Objective: High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems. Design: Manometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders. Results: Of 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions. Conclusions: Motor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.
KW - Distal Contractile Integral
KW - Distal Latency
KW - High-Resolution Manometry
KW - Integrated Relaxation Pressure
UR - http://www.scopus.com/inward/record.url?scp=85098236599&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2020.10.052
DO - 10.1016/j.cgh.2020.10.052
M3 - Article
C2 - 33144149
AN - SCOPUS:85098236599
SN - 1542-3565
VL - 20
SP - e398-e406
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -