Document Detail


Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes.
MedLine Citation:
PMID:  21679709     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The manometric diagnosis of distal esophageal spasm (DES) uses "simultaneous contractions" as a defining criterion, ignoring the concept of short latency distal contractions as an important feature. Our aim was to apply standardized metrics of contraction velocity and latency to high-resolution esophageal pressure topography (EPT) studies to refine the diagnosis of DES.
METHODS: Two thousand consecutive EPT studies were analyzed for contractile front velocity (CFV) and distal latency to identify patients potentially having DES. Normal limits for CFV and distal latency were established from 75 control subjects. Clinical data of patients with reduced distal latency and/or rapid CFV were reviewed.
RESULTS: Of 1070 evaluable patients, 91 (8.5%) had a high CFV and/or low distal latency. Patients with only rapid contractions (n = 186 [17.4%] using conventional manometry criteria; n = 85 [7.9%] using EPT criteria) were heterogeneous in diagnosis and symptoms, with the majority ultimately categorized as weak peristalsis or normal. In contrast, 96% of patients with premature contraction had dysphagia, and all (n = 24; 2.2% overall) were ultimately managed as spastic achalasia or DES.
CONCLUSIONS: The current DES diagnostic paradigm focused on "simultaneous contractions" identifies a large heterogeneous set of patients, most of whom do not have a clinical syndrome suggestive of esophageal spasm. Incorporating distal latency into the diagnostic algorithm of EPT studies improves upon this by isolating disorders of homogeneous pathophysiology: DES with short latency and spastic achalasia. We hypothesize that prioritizing measurement of distal latency will refine the management of these disorders, recognizing that outcomes trials are necessary.
Authors:
John E Pandolfino; Sabine Roman; Dustin Carlson; Daniel Luger; Kiran Bidari; Lubomyr Boris; Monika A Kwiatek; Peter J Kahrilas
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2011-05-06
Journal Detail:
Title:  Gastroenterology     Volume:  141     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-08     Completed Date:  2011-10-13     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  469-75     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA. j-pandolfino@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Deglutition / physiology
Esophageal Spasm, Diffuse / diagnosis*,  physiopathology
Humans
Manometry / methods*
Muscle Contraction / physiology*
Muscle, Smooth / physiopathology*
Pressure
Retrospective Studies
Grant Support
ID/Acronym/Agency:
R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902-04/DK/NIDDK NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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