Document Detail


Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model.
MedLine Citation:
PMID:  22716041     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Integrated Relaxation Pressure (IRP) is the esophageal pressure topography (EPT) metric used for assessing the adequacy of esophagogastric junction (EGJ) relaxation in the Chicago Classification of motility disorders. However, because the IRP value is also influenced by distal esophageal contractility, we hypothesized that its normal limits should vary with different patterns of contractility.
METHODS: Five hundred and twenty two selected EPT studies were used to compare the accuracy of alternative analysis paradigms to that of a motility expert (the 'gold standard'). Chicago Classification metrics were scored manually and used as inputs for MATLAB™ programs that utilized either strict algorithm-based interpretation (fixed abnormal IRP threshold of 15 mmHg) or a classification and regression tree (CART) model that selected variable IRP thresholds depending on the associated esophageal contractility.
KEY RESULTS: The sensitivity of the CART model for achalasia (93%) was better than that of the algorithm-based approach (85%) on account of using variable IRP thresholds that ranged from a low value of >10 mmHg to distinguish type I achalasia from absent peristalsis to a high value of >17 mmHg to distinguish type III achalasia from distal esophageal spasm. Additionally, type II achalasia was diagnosed solely by panesophageal pressurization without the IRP entering the algorithm.
CONCLUSIONS & INFERENCES: Automated interpretation of EPT studies more closely mimics that of a motility expert when IRP thresholds for impaired EGJ relaxation are adjusted depending on the pattern of associated esophageal contractility. The range of IRP cutoffs suggested by the CART model ranged from 10 to 17 mmHg.
Authors:
Zhiyue Lin; P J Kahrilas; S Roman; L Boris; D Carlson; J E Pandolfino
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-20
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  24     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-12     Completed Date:  2012-11-16     Revised Date:  2013-08-13    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e356-63     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611-2951, USA. z-lin@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Algorithms*
Animals
Esophageal Motility Disorders / diagnosis*
Esophagus / physiology
Gastroenterology / methods*
Humans
Manometry / methods*
Muscle Contraction / physiology
Regression (Psychology)
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK56033/DK/NIDDK NIH HHS
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