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Classifying Esophageal Motility by Pressure Topography Characteristics

A Study of 400 Patients and 75 Controls

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

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 27–37
ORIGINAL CONTRIBUTIONS: ESOPHAGUS
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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.

Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Reprint requests and correspondence: John E. Pandolfino, M.D., Department of Medicine, Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1400, Chicago, IL 60611.

Received July 5, 2007; accepted August 2, 2007.

CONFLICT OF INTERESTGuarantor of the article: John Pandolfino, M.D.

Specific author contributions: John Pandolfino: hypothesis, data analysis, statistics, main coauthor; Sudip Ghosh: developed analysis software, created figures, data analysis-statistics; John Rice: performed studies, created database for analysis; John O'Clarke: data analysis, performed studies; Monica Kwiatek: data analysis, performed studies; Peter Kahrilas: hypothesis, data analysis, main coauthor.

Financial support: No direct support was received for this study. Dr. Pandolfino and Dr. Kahrilas were supported by RO1 DC00646 (PJK) and K23 DK062170-01 (JEP) from the Public Health Service.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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