Impaired deglutitive EGJ relaxation in clinical esophageal manometry: A quantitative analysis of 400 patients and 75 controls

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

Research output: Contribution to journalArticle

Abstract

Assessing deglutitive esophagogastric junction (EGJ) relaxation is an essential focus of clinical manometry. Our aim was to apply automated algorithmic analyses to high-resolution manometry (HRM) studies to ascertain the optimal method for discriminating normal from abnormal deglutitive EGJ relaxation. All 473 subjects (73 controls) were studied with a 36-channel solid-state HRM assembly during water swallows. Patients were classified as: 1) achalasia, 2) postfundoplication, 3) nonachalasia with normal deglutitive EGJ relaxation, or 4) functional obstruction (preserved peristalsis with incomplete EGJ relaxation). Automated computer programs assessed the adequacy of EGJ relaxation by using progressively complex analysis routines to compensate for esophageal shortening, crural diaphragm contraction, and catheter movement, all potential confounders. The single-sensor method of assessing EGJ relaxation had a sensitivity of only 52% for detecting achalasia. Of the automated HRM analysis paradigms tested, the 4-s integrated relaxation pressure using a cutoff of 15 mmHg performed optimally with 98% sensitivity and 96% specificity in the detection of achalasia. We also identified a heterogeneous group of 26 patients with functional EGJ obstruction attributed to variant achalasia and other diverse pathology. Although further clinical experience will ultimately judge, it is our expectation that applying rigorous methodology such as described herein to the analysis of HRM studies will improve the consistency in the interpretation of clinical manometry and prove useful in guiding clinical management.

Original languageEnglish (US)
JournalAmerican Journal of Physiology - Gastrointestinal and Liver Physiology
Volume293
Issue number4
DOIs
StatePublished - Oct 2007
Externally publishedYes

Fingerprint

Esophagogastric Junction
Manometry
Esophageal Achalasia
Swallows
Peristalsis
Diaphragm
Leg
Software
Catheters
Pathology
Pressure
Sensitivity and Specificity
Water

Keywords

  • Achalasia
  • Esophageal manometry
  • Esophagogastric junction
  • Lower esophageal sphincter

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Impaired deglutitive EGJ relaxation in clinical esophageal manometry : A quantitative analysis of 400 patients and 75 controls. / Ghosh, Sudip K.; Pandolfino, John E.; Rice, John; Clarke, John O.; Kwiatek, Monika; Kahrilas, Peter J.

In: American Journal of Physiology - Gastrointestinal and Liver Physiology, Vol. 293, No. 4, 10.2007.

Research output: Contribution to journalArticle

Ghosh, Sudip K. ; Pandolfino, John E. ; Rice, John ; Clarke, John O. ; Kwiatek, Monika ; Kahrilas, Peter J. / Impaired deglutitive EGJ relaxation in clinical esophageal manometry : A quantitative analysis of 400 patients and 75 controls. In: American Journal of Physiology - Gastrointestinal and Liver Physiology. 2007 ; Vol. 293, No. 4.
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