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John E Pandolfino - One of the best experts on this subject based on the ideXlab platform.
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improved assessment of bolus clearance in patients with achalasia using high resolution impedance manometry
Clinical Gastroenterology and Hepatology, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Zhiyue Lin, Michael Y Tye, Katherine Ritter, Claire Beveridge, Michelle Balla, Dyanna L Gregory, John E PandolfinoAbstract:Background & Aims Esophageal retention is typically evaluated by timed-barium esophagram in patients treated for achalasia. Esophageal bolus clearance can also be evaluated using high-resolution impedance manometry. We evaluated the associations of conventional and novel high-resolution impedance manometry metrics, esophagram, and patient-reported outcomes (PROs) in achalasia. Methods We performed a prospective study of 70 patients with achalasia (age, 20–81 y; 30 women) treated by pneumatic dilation or myotomy who underwent follow-up evaluations from April 2013 through December 2015 (median, 12 mo after treatment; range, 3–183 mo). Patients were assessed using timed-barium esophagrams, high-resolution impedance manometry, and PROs, determined from Eckardt scores (the primary outcome) and the brief Esophageal Dysphagia questionnaire. Barium column height was measured from esophagrams taken 5 minutes after ingestion of barium (200 mL). Impedance-manometry was analyzed for bolus transit (dichotomized) and with a customized MATLAB program (The MathWorks, Inc, Natick, MA) to calculate the Esophageal impedance integral (EII) ratio. Results Optimal cut points to identify a good PRO (defined as Eckardt score of ≤3) were esophagram barium column height of 3 cm (identified patients with a good PRO with 63% sensitivity and 75% specificity) and an EII ratio of 0.41 (identified patients with a good PRO with 83% sensitivity and 75% specificity). Complete bolus transit identified patients with a good PRO with 28% sensitivity and 75% specificity. Of the 25 patients who met these cut points for both esophagram barium column height and EII ratio, 23 (92%) had a good PRO. Of the 17 patients who met neither cut point, 14 (82%) had a poor PRO (Eckardt score above 3). Conclusions In a prospective study of 70 patients with achalasia, we found EII ratio identified patients with good PROs with higher levels of sensitivity (same specificity) than timed-barium esophagram or impedance-manometry bolus transit assessments. The EII ratio should be added to achalasia outcome evaluations that involve high-resolution impedance manometry as an independent measure and to complement timed-barium esophagram.
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high resolution manometry assessment of the lower Esophageal sphincter after contraction normative values and clinical correlation
Neurogastroenterology and Motility, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Michael Y Tye, Zoe Listernick, Katherine Ritter, I Wong, Yinglian Xiao, V Bul, John E PandolfinoAbstract:BACKGROUND The Chicago Classification v3.0 proposed extending the distal contractile integral (DCI) measurement domain to include the lower Esophageal sphincter (LES) to enhance the detection of Esophageal hypercontractility. However, normative and clinical data for this approach are unreported. We aimed to describe the application of an extended DCI measurement in asymptomatic controls and patients. METHODS High-resolution manometry (HRM) of 65 asymptomatic controls and 72 patients with normal motility were evaluated retrospectively. Dysphagia and chest pain symptoms were assessed using the brief Esophageal Dysphagia questionnaire (BEDQ); ≥10 was considered abnormal. HRM studies of 10 supine swallows were evaluated via the standard DCI and an extended DCI measurement domain (DCI+) to include the lower Esophageal sphincter (LES) during and after the peristaltic wave. The DCI-increment was calculated as the DCI+ minus DCI. KEY RESULTS Among controls, the median (5-95th percentile) DCI+ was 1915 (1359-6921) mm Hg/cm/s and DCI-increment was 534 (126-1488) mm Hg/cm/s. Two patients (3%) had ≥2 swallows with DCI+ >8000 mm Hg/cm/s and seven (10%) patients had at least one swallow with DCI+ >8000 mm Hg/cm/s, ie, had potential motility reclassification by application of DCI+. Seven of these nine patients (78%) were evaluated for Dysphagia or chest pain, but only 3/9 (33%) had an abnormal BEDQ. CONCLUSIONS AND INFERENCES Extension of the DCI measurement domain may aid quantifying hypercontractility that involves the LES. However, adjusting management strategies based on reclassification of patients with otherwise normal motility should be cautiously considered.
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high resolution impedance manometry parameters enhance the Esophageal motility evaluation in non obstructive Dysphagia patients without a major chicago classification motility disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive Dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for Dysphagia and 23 for reflux (non-Dysphagia patients), with Esophageal motility diagnoses of normal motility or ineffective Esophageal motility, were evaluated with HRIM and a global Dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and Dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated Dysphagia from non-Dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive Dysphagia without a major Esophageal motility disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with Dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
Dustin A Carlson - One of the best experts on this subject based on the ideXlab platform.
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Esophageal hypervigilance and visceral anxiety are contributors to symptom severity among patients evaluated with high resolution Esophageal manometry
The American Journal of Gastroenterology, 2020Co-Authors: Dustin A Carlson, Tiffany Taft, Joseph Triggs, Prakash C Gyawali, Marcelo F Vela, Karthik Ravi, Farhan Quader, Michael D. Crowell, Sabine Roman, Jacqueline PrescottAbstract:OBJECTIVES: Symptoms are inconsistently associated with Esophageal motor findings on high-resolution manometry (HRM). We aimed to evaluate predictors of Dysphagia severity, including Esophageal hypervigilance and visceral anxiety, among patients evaluated with HRM. METHODS: Adult patients undergoing HRM at 4 academic medical centers (United States and France) were prospectively evaluated. HRM was completed and analyzed per the Chicago Classification v3.0. Validated symptom scores, including the Brief Esophageal Dysphagia Questionnaire and Esophageal Hypervigilance and Anxiety Scale, were completed at the time of HRM. RESULTS: Two hundred thirty-six patients, aged 18-85 (mean 53) years, 65% female, were included. Approximately 59 (25%) patients had a major motor disorder on HRM: 19 achalasia, 24 esophagogastric junction outflow obstruction, 12 absent contractility, and 4 jackhammer. Approximately 177 (75%) patients did not have a major motor disorder: 71 ineffective Esophageal motility and 106 normal motility. Having a major motor disorder was a significant predictor of Dysphagia severity (Radj = 0.049, P < 0.001), but the Esophageal Hypervigilance and Anxiety Scale score carried a predictive relationship of Brief Esophageal Dysphagia Questionnaire that was 2-fold higher than having a major motor disorder: Radj = 0.118 (P < 0.001). This finding remained when evaluated by the major motor disorder group. HRM metrics were nonsignificant. DISCUSSION: In a prospective, international multicenter study, we found that Esophageal hypervigilance and visceral anxiety were the strongest predictors of Dysphagia severity among patients evaluated with HRM. Thus, an assessment of Esophageal hypervigilance and visceral anxiety is important to incorporate when evaluating symptom severity in clinical practice and research studies.
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improved assessment of bolus clearance in patients with achalasia using high resolution impedance manometry
Clinical Gastroenterology and Hepatology, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Zhiyue Lin, Michael Y Tye, Katherine Ritter, Claire Beveridge, Michelle Balla, Dyanna L Gregory, John E PandolfinoAbstract:Background & Aims Esophageal retention is typically evaluated by timed-barium esophagram in patients treated for achalasia. Esophageal bolus clearance can also be evaluated using high-resolution impedance manometry. We evaluated the associations of conventional and novel high-resolution impedance manometry metrics, esophagram, and patient-reported outcomes (PROs) in achalasia. Methods We performed a prospective study of 70 patients with achalasia (age, 20–81 y; 30 women) treated by pneumatic dilation or myotomy who underwent follow-up evaluations from April 2013 through December 2015 (median, 12 mo after treatment; range, 3–183 mo). Patients were assessed using timed-barium esophagrams, high-resolution impedance manometry, and PROs, determined from Eckardt scores (the primary outcome) and the brief Esophageal Dysphagia questionnaire. Barium column height was measured from esophagrams taken 5 minutes after ingestion of barium (200 mL). Impedance-manometry was analyzed for bolus transit (dichotomized) and with a customized MATLAB program (The MathWorks, Inc, Natick, MA) to calculate the Esophageal impedance integral (EII) ratio. Results Optimal cut points to identify a good PRO (defined as Eckardt score of ≤3) were esophagram barium column height of 3 cm (identified patients with a good PRO with 63% sensitivity and 75% specificity) and an EII ratio of 0.41 (identified patients with a good PRO with 83% sensitivity and 75% specificity). Complete bolus transit identified patients with a good PRO with 28% sensitivity and 75% specificity. Of the 25 patients who met these cut points for both esophagram barium column height and EII ratio, 23 (92%) had a good PRO. Of the 17 patients who met neither cut point, 14 (82%) had a poor PRO (Eckardt score above 3). Conclusions In a prospective study of 70 patients with achalasia, we found EII ratio identified patients with good PROs with higher levels of sensitivity (same specificity) than timed-barium esophagram or impedance-manometry bolus transit assessments. The EII ratio should be added to achalasia outcome evaluations that involve high-resolution impedance manometry as an independent measure and to complement timed-barium esophagram.
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high resolution manometry assessment of the lower Esophageal sphincter after contraction normative values and clinical correlation
Neurogastroenterology and Motility, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Michael Y Tye, Zoe Listernick, Katherine Ritter, I Wong, Yinglian Xiao, V Bul, John E PandolfinoAbstract:BACKGROUND The Chicago Classification v3.0 proposed extending the distal contractile integral (DCI) measurement domain to include the lower Esophageal sphincter (LES) to enhance the detection of Esophageal hypercontractility. However, normative and clinical data for this approach are unreported. We aimed to describe the application of an extended DCI measurement in asymptomatic controls and patients. METHODS High-resolution manometry (HRM) of 65 asymptomatic controls and 72 patients with normal motility were evaluated retrospectively. Dysphagia and chest pain symptoms were assessed using the brief Esophageal Dysphagia questionnaire (BEDQ); ≥10 was considered abnormal. HRM studies of 10 supine swallows were evaluated via the standard DCI and an extended DCI measurement domain (DCI+) to include the lower Esophageal sphincter (LES) during and after the peristaltic wave. The DCI-increment was calculated as the DCI+ minus DCI. KEY RESULTS Among controls, the median (5-95th percentile) DCI+ was 1915 (1359-6921) mm Hg/cm/s and DCI-increment was 534 (126-1488) mm Hg/cm/s. Two patients (3%) had ≥2 swallows with DCI+ >8000 mm Hg/cm/s and seven (10%) patients had at least one swallow with DCI+ >8000 mm Hg/cm/s, ie, had potential motility reclassification by application of DCI+. Seven of these nine patients (78%) were evaluated for Dysphagia or chest pain, but only 3/9 (33%) had an abnormal BEDQ. CONCLUSIONS AND INFERENCES Extension of the DCI measurement domain may aid quantifying hypercontractility that involves the LES. However, adjusting management strategies based on reclassification of patients with otherwise normal motility should be cautiously considered.
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high resolution impedance manometry parameters enhance the Esophageal motility evaluation in non obstructive Dysphagia patients without a major chicago classification motility disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive Dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for Dysphagia and 23 for reflux (non-Dysphagia patients), with Esophageal motility diagnoses of normal motility or ineffective Esophageal motility, were evaluated with HRIM and a global Dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and Dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated Dysphagia from non-Dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive Dysphagia without a major Esophageal motility disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with Dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
Nathalie Rommel - One of the best experts on this subject based on the ideXlab platform.
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buspirone a new drug for the management of patients with ineffective Esophageal motility
United European gastroenterology journal, 2015Co-Authors: Charlotte Scheerens, Jan Tack, Nathalie RommelAbstract:Ineffective Esophageal motility (IEM) is the most frequently encountered Esophageal motility disorder. Patients may present with a variety of symptoms, such as Dysphagia, heartburn, odynophagia, and regurgitation. Over the past years, the landscape of Esophageal motility testing has been revolutionized; however, our current treatment options for IEM still remain limited. Previous studies have suggested that buspirone, a serotonin receptor agonist, enhances Esophageal peristalsis and lower Esophageal sphincter (LES) function. Recent work provides the first evidence that buspirone may influence LES resting pressure in patients with systemic sclerosis. Future research should evaluate whether the beneficial effects of buspirone also apply to the broad clinical entity of Esophageal Dysphagia patients with IEM.
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automated impedance manometry analysis as a method to assess Esophageal function
Neurogastroenterology and Motility, 2014Co-Authors: Nathalie Rommel, Jan Tack, L Van Oudenhove, Taher OmariAbstract:Background Diagnostic evaluation of non-achalasia Esophageal Dysphagia remains challenging because of a lack of a clear relationship between symptoms, Esophageal contraction patterns, and Esophageal bolus flow. This study evaluates a novel approach to pressure-impedance analysis called automated impedance manometry (AIM) analysis in relation to bolus characteristics, Chicago classification metrics, bolus perception, and Dysphagia. Methods AIM analysis was performed on Esophageal high resolution manometry-impedance recordings from 12 healthy controls and 15 patients with Dysphagia. In each subject, 10 liquid, 10 semisolid, and 10 solid swallows were analyzed using AIMplot software. Key Results This study demonstrated that (i) Esophageal pressure-flow parameters differ with bolus type (liquid, semisolid, and solids), (ii) impedance at peak pressure parameter can discriminate normal from dysphagic subjects with high accuracy on a cut-off threshold at 2400 Ohms (kappa 0.77, sensitivity 0.83, and specificity 0.93), and (iii) nadir impedance and impedance at peak pressure highly correlate with perception of Esophageal bolus flow (r = −0.65, p = 0.02; r = −0.70, p = 0.01 resp). Conclusions & Inferences This study presents novel Esophageal pressure-flow variables in control subjects and in a cohort of patients with Dysphagia. These variables are altered in relation to bolus consistency and can discriminate between subjects with and without symptoms of Dysphagia. For the first time, we present high resolution Esophageal pressure-flow variables that accurately link in with patient perception of Esophageal bolus hold up.
Peter J. Kahrilas - One of the best experts on this subject based on the ideXlab platform.
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improved assessment of bolus clearance in patients with achalasia using high resolution impedance manometry
Clinical Gastroenterology and Hepatology, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Zhiyue Lin, Michael Y Tye, Katherine Ritter, Claire Beveridge, Michelle Balla, Dyanna L Gregory, John E PandolfinoAbstract:Background & Aims Esophageal retention is typically evaluated by timed-barium esophagram in patients treated for achalasia. Esophageal bolus clearance can also be evaluated using high-resolution impedance manometry. We evaluated the associations of conventional and novel high-resolution impedance manometry metrics, esophagram, and patient-reported outcomes (PROs) in achalasia. Methods We performed a prospective study of 70 patients with achalasia (age, 20–81 y; 30 women) treated by pneumatic dilation or myotomy who underwent follow-up evaluations from April 2013 through December 2015 (median, 12 mo after treatment; range, 3–183 mo). Patients were assessed using timed-barium esophagrams, high-resolution impedance manometry, and PROs, determined from Eckardt scores (the primary outcome) and the brief Esophageal Dysphagia questionnaire. Barium column height was measured from esophagrams taken 5 minutes after ingestion of barium (200 mL). Impedance-manometry was analyzed for bolus transit (dichotomized) and with a customized MATLAB program (The MathWorks, Inc, Natick, MA) to calculate the Esophageal impedance integral (EII) ratio. Results Optimal cut points to identify a good PRO (defined as Eckardt score of ≤3) were esophagram barium column height of 3 cm (identified patients with a good PRO with 63% sensitivity and 75% specificity) and an EII ratio of 0.41 (identified patients with a good PRO with 83% sensitivity and 75% specificity). Complete bolus transit identified patients with a good PRO with 28% sensitivity and 75% specificity. Of the 25 patients who met these cut points for both esophagram barium column height and EII ratio, 23 (92%) had a good PRO. Of the 17 patients who met neither cut point, 14 (82%) had a poor PRO (Eckardt score above 3). Conclusions In a prospective study of 70 patients with achalasia, we found EII ratio identified patients with good PROs with higher levels of sensitivity (same specificity) than timed-barium esophagram or impedance-manometry bolus transit assessments. The EII ratio should be added to achalasia outcome evaluations that involve high-resolution impedance manometry as an independent measure and to complement timed-barium esophagram.
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high resolution manometry assessment of the lower Esophageal sphincter after contraction normative values and clinical correlation
Neurogastroenterology and Motility, 2018Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Michael Y Tye, Zoe Listernick, Katherine Ritter, I Wong, Yinglian Xiao, V Bul, John E PandolfinoAbstract:BACKGROUND The Chicago Classification v3.0 proposed extending the distal contractile integral (DCI) measurement domain to include the lower Esophageal sphincter (LES) to enhance the detection of Esophageal hypercontractility. However, normative and clinical data for this approach are unreported. We aimed to describe the application of an extended DCI measurement in asymptomatic controls and patients. METHODS High-resolution manometry (HRM) of 65 asymptomatic controls and 72 patients with normal motility were evaluated retrospectively. Dysphagia and chest pain symptoms were assessed using the brief Esophageal Dysphagia questionnaire (BEDQ); ≥10 was considered abnormal. HRM studies of 10 supine swallows were evaluated via the standard DCI and an extended DCI measurement domain (DCI+) to include the lower Esophageal sphincter (LES) during and after the peristaltic wave. The DCI-increment was calculated as the DCI+ minus DCI. KEY RESULTS Among controls, the median (5-95th percentile) DCI+ was 1915 (1359-6921) mm Hg/cm/s and DCI-increment was 534 (126-1488) mm Hg/cm/s. Two patients (3%) had ≥2 swallows with DCI+ >8000 mm Hg/cm/s and seven (10%) patients had at least one swallow with DCI+ >8000 mm Hg/cm/s, ie, had potential motility reclassification by application of DCI+. Seven of these nine patients (78%) were evaluated for Dysphagia or chest pain, but only 3/9 (33%) had an abnormal BEDQ. CONCLUSIONS AND INFERENCES Extension of the DCI measurement domain may aid quantifying hypercontractility that involves the LES. However, adjusting management strategies based on reclassification of patients with otherwise normal motility should be cautiously considered.
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high resolution impedance manometry parameters enhance the Esophageal motility evaluation in non obstructive Dysphagia patients without a major chicago classification motility disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive Dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for Dysphagia and 23 for reflux (non-Dysphagia patients), with Esophageal motility diagnoses of normal motility or ineffective Esophageal motility, were evaluated with HRIM and a global Dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and Dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated Dysphagia from non-Dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive Dysphagia without a major Esophageal motility disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with Dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
Taher Omari - One of the best experts on this subject based on the ideXlab platform.
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high resolution impedance manometry parameters enhance the Esophageal motility evaluation in non obstructive Dysphagia patients without a major chicago classification motility disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive Dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for Dysphagia and 23 for reflux (non-Dysphagia patients), with Esophageal motility diagnoses of normal motility or ineffective Esophageal motility, were evaluated with HRIM and a global Dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and Dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated Dysphagia from non-Dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive Dysphagia without a major Esophageal motility disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with Dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
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automated impedance manometry analysis as a method to assess Esophageal function
Neurogastroenterology and Motility, 2014Co-Authors: Nathalie Rommel, Jan Tack, L Van Oudenhove, Taher OmariAbstract:Background Diagnostic evaluation of non-achalasia Esophageal Dysphagia remains challenging because of a lack of a clear relationship between symptoms, Esophageal contraction patterns, and Esophageal bolus flow. This study evaluates a novel approach to pressure-impedance analysis called automated impedance manometry (AIM) analysis in relation to bolus characteristics, Chicago classification metrics, bolus perception, and Dysphagia. Methods AIM analysis was performed on Esophageal high resolution manometry-impedance recordings from 12 healthy controls and 15 patients with Dysphagia. In each subject, 10 liquid, 10 semisolid, and 10 solid swallows were analyzed using AIMplot software. Key Results This study demonstrated that (i) Esophageal pressure-flow parameters differ with bolus type (liquid, semisolid, and solids), (ii) impedance at peak pressure parameter can discriminate normal from dysphagic subjects with high accuracy on a cut-off threshold at 2400 Ohms (kappa 0.77, sensitivity 0.83, and specificity 0.93), and (iii) nadir impedance and impedance at peak pressure highly correlate with perception of Esophageal bolus flow (r = −0.65, p = 0.02; r = −0.70, p = 0.01 resp). Conclusions & Inferences This study presents novel Esophageal pressure-flow variables in control subjects and in a cohort of patients with Dysphagia. These variables are altered in relation to bolus consistency and can discriminate between subjects with and without symptoms of Dysphagia. For the first time, we present high resolution Esophageal pressure-flow variables that accurately link in with patient perception of Esophageal bolus hold up.