Document Detail


High-resolution manometry correlates of ineffective esophageal motility.
MedLine Citation:
PMID:  22929758     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: There are currently no criteria for ineffective esophageal motility (IEM) and ineffective swallow (IES) in esophageal pressure topography (EPT). Our aims were to use high-resolution manometry metrics to define IEM within the Chicago Classification and to determine the distal contractile integral (DCI) threshold for IES.
METHODS: The EPT of 150 patients with either dysphagia or reflux symptoms were reviewed. Peristaltic function in EPT was defined by the Chicago Classification; the corresponding conventional line tracing (CLT) were reviewed separately. Generalized linear mixed models were used to find thresholds for DCI corresponding to traditionally determined IES and failed swallows. An external validation sample was used to confirm these thresholds.
RESULTS: In terms of swallow subtypes, IES in CLT were a mixture of normal, weak, and failed peristalsis in EPT. A DCI of 450 mm Hg-s-cm was determined to be optimal in predicting IES. In the validation sample, the threshold of 450 mm Hg-s-cm showed strong agreement with CLT determination of IES (positive percent agreement 83%, negative percent agreement 90%). The patient diagnostic level agreement between CLT and EPT was good (78.6% positive percent agreement and 63.9% negative percent agreement), with negative agreement increasing to 92.0% if proximal breaks were excluded.
CONCLUSIONS: The manometric correlate of IEM in EPT is a mixture of failed swallows and weak swallows with breaks in the middle/distal troughs. A DCI value <450 mm Hg-s-cm can be used to predict IES previously defined in CLT. IEM can be defined by >5 swallows with weak/failed peristalsis or with a DCI <450 mm Hg-s-cm.
Authors:
Yinglian Xiao; Peter J Kahrilas; Mary J Kwasny; Sabine Roman; Zhiyue Lin; Frédéric Nicodème; Chang Lu; John E Pandolfino
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-08-28
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  107     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-02-11     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1647-54     Citation Subset:  IM    
Affiliation:
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA. yinglian.xiao@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Esophageal Motility Disorders / physiopathology*
Female
Humans
Linear Models
Male
Manometry / methods*
Middle Aged
Peristalsis / physiology
Predictive Value of Tests
Software
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK092217/DK/NIDDK NIH HHS; R01 DK56033/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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