Classifying esophageal motility by pressure topography characteristics: A study of 400 patients and 75 controls

John E. Pandolfino, Sudip K. Ghosh, John Rice, John O. Clarke, Monika A. Kwiatek, Peter J. Kahrilas

Research output: Contribution to journalArticle

Abstract

AIM: This study aimed to devise a scheme for the systematic analysis of esophageal high-resolution manometry (HRM) studies displayed using topographic plotting. METHODS: A total of 400 patients and 75 control subjects were studied with a 36-channel HRM assembly. Studies were analyzed in a stepwise fashion for: (a) the adequacy of deglutitive esophagogastric junction (EGJ) relaxation, (b) the presence and propagation characteristics of distal esophageal persitalsis, and (c) an integral of the magnitude and span of the distal esophageal contraction. RESULTS: Two strengths of pressure topography plots compared to conventional manometric recordings were: (a) the ability to delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus, and (b) the ability to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm (DES), vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: (a) DES in 1.5% patients, (b) vigorous achalasia in 1.5%, and (c) a newly defined entity, spastic nutcracker, in 1.5%. CONCLUSIONS: We developed a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant scheme is consistent with conventional classifications with the caveats that: (a) hypercontractile conditions are more specifically defined, (b) distinctions are made between rapidly propagated contractions and compartmentalized esophageal pressurization, and (c) there is no "nonspecific esophageal motor disorder" classification. We expect that pressure topography analysis, with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders.

Original languageEnglish (US)
Pages (from-to)27-37
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume103
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

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Manometry
Diffuse Esophageal Spasm
Esophageal Motility Disorders
Esophageal Achalasia
Aptitude
Muscle Spasticity
Pressure
Esophagogastric Junction
Esophagus

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Classifying esophageal motility by pressure topography characteristics : A study of 400 patients and 75 controls. / Pandolfino, John E.; Ghosh, Sudip K.; Rice, John; Clarke, John O.; Kwiatek, Monika A.; Kahrilas, Peter J.

In: American Journal of Gastroenterology, Vol. 103, No. 1, 01.2008, p. 27-37.

Research output: Contribution to journalArticle

Pandolfino, John E. ; Ghosh, Sudip K. ; Rice, John ; Clarke, John O. ; Kwiatek, Monika A. ; Kahrilas, Peter J. / Classifying esophageal motility by pressure topography characteristics : A study of 400 patients and 75 controls. In: American Journal of Gastroenterology. 2008 ; Vol. 103, No. 1. pp. 27-37.
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abstract = "AIM: This study aimed to devise a scheme for the systematic analysis of esophageal high-resolution manometry (HRM) studies displayed using topographic plotting. METHODS: A total of 400 patients and 75 control subjects were studied with a 36-channel HRM assembly. Studies were analyzed in a stepwise fashion for: (a) the adequacy of deglutitive esophagogastric junction (EGJ) relaxation, (b) the presence and propagation characteristics of distal esophageal persitalsis, and (c) an integral of the magnitude and span of the distal esophageal contraction. RESULTS: Two strengths of pressure topography plots compared to conventional manometric recordings were: (a) the ability to delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus, and (b) the ability to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm (DES), vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: (a) DES in 1.5{\%} patients, (b) vigorous achalasia in 1.5{\%}, and (c) a newly defined entity, spastic nutcracker, in 1.5{\%}. CONCLUSIONS: We developed a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant scheme is consistent with conventional classifications with the caveats that: (a) hypercontractile conditions are more specifically defined, (b) distinctions are made between rapidly propagated contractions and compartmentalized esophageal pressurization, and (c) there is no {"}nonspecific esophageal motor disorder{"} classification. We expect that pressure topography analysis, with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders.",
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