TY - JOUR
T1 - Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes
AU - Blais, P.
AU - Patel, A.
AU - Sayuk, G. S.
AU - Gyawali, C. P.
N1 - Funding Information:
Funding information This study was partially funded through NIH/NIDDK (T32 DK007130-AP; NIH K23DK84413-4-GSS). CPG has received research funding from Medtronic, Inc, but not for the current project. He is also on the speaker's bureau for Medtronic, Inc. No competing interests exist for the other authors.
Funding Information:
This study was partially funded through NIH/NIDDK (T32 DK007130-AP; NIH K23DK84413-4-GSS).
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/12
Y1 - 2017/12
N2 - Background: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. Methods: Within consecutive patients undergoing esophageal high-resolution manometry (HRM), 302 patients (58.2±1.0 year, 57% F) with esophageal outflow obstruction were identified, and compared to 16 asymptomatic controls (27.7±0.7 year, 56% F). Esophageal outflow obstruction was segregated into achalasia subtypes 1, 2, and 3, and esophagogastric junction outflow obstruction (EGJOO with intact peristalsis) using Chicago Classification v3.0. UES and lower esophageal sphincter (LES) metrics were compared between esophageal outflow obstruction and normal controls using univariate and multivariate analysis. Linear regression excluded multicollinearity of pressure metrics that demonstrated significant differences across individual subtype comparisons. Key Results: LES integrated relaxation pressure (IRP) had utility in differentiating achalasia from controls (P<.0001), but no utility in segregating between subtypes (P=.27). In comparison to controls, patients collectively demonstrated univariate differences in UES mean basal pressure, relaxation time to nadir, recovery time, and residual pressure (UES-RP) (P≤.049). UES-RP was highest in type 2 achalasia (P<.0001 compared to other subtypes and controls). In multivariate analysis, only UES-RP retained significance in comparison between each of the subgroups (P≤.02 for each comparison). Intrabolus pressure was highest in type 3 achalasia; this demonstrated significant differences across some but not all subtype comparisons. Conclusions and Inferences: Nadir UES-RP can differentiate achalasia subtypes within the esophageal outflow obstruction spectrum, with highest values in type 2 achalasia. This metric likely represents a surrogate marker for esophageal pressurization.
AB - Background: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. Methods: Within consecutive patients undergoing esophageal high-resolution manometry (HRM), 302 patients (58.2±1.0 year, 57% F) with esophageal outflow obstruction were identified, and compared to 16 asymptomatic controls (27.7±0.7 year, 56% F). Esophageal outflow obstruction was segregated into achalasia subtypes 1, 2, and 3, and esophagogastric junction outflow obstruction (EGJOO with intact peristalsis) using Chicago Classification v3.0. UES and lower esophageal sphincter (LES) metrics were compared between esophageal outflow obstruction and normal controls using univariate and multivariate analysis. Linear regression excluded multicollinearity of pressure metrics that demonstrated significant differences across individual subtype comparisons. Key Results: LES integrated relaxation pressure (IRP) had utility in differentiating achalasia from controls (P<.0001), but no utility in segregating between subtypes (P=.27). In comparison to controls, patients collectively demonstrated univariate differences in UES mean basal pressure, relaxation time to nadir, recovery time, and residual pressure (UES-RP) (P≤.049). UES-RP was highest in type 2 achalasia (P<.0001 compared to other subtypes and controls). In multivariate analysis, only UES-RP retained significance in comparison between each of the subgroups (P≤.02 for each comparison). Intrabolus pressure was highest in type 3 achalasia; this demonstrated significant differences across some but not all subtype comparisons. Conclusions and Inferences: Nadir UES-RP can differentiate achalasia subtypes within the esophageal outflow obstruction spectrum, with highest values in type 2 achalasia. This metric likely represents a surrogate marker for esophageal pressurization.
KW - achalasia
KW - esophageal pressurization
KW - esophagogastric junction outflow obstruction (EGJOO)
KW - high-resolution manometry (HRM)
KW - upper esophageal sphincter
UR - http://www.scopus.com/inward/record.url?scp=85023600243&partnerID=8YFLogxK
U2 - 10.1111/nmo.13136
DO - 10.1111/nmo.13136
M3 - Article
C2 - 28707402
AN - SCOPUS:85023600243
VL - 29
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
SN - 1350-1925
IS - 12
M1 - e13136
ER -