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The Clinical Utility of Esophageal Manometry

41

Lacy, Brian E., Ph.D., M.D.; Paquette, Lisa, R.N.; Robertson, Douglas, M.D.; Weiss, Julia, MA; Bauer, David, B.A.; Kelley, Maurice L. Jr., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S36
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Medicine, White River Junction VA Medical Center, White River Junction, VT and Biostatistics, Dartmouth Medical School, Hanover, NH.

Purpose: Esophageal manometry (EM) is routinely ordered in the evaluation of patients (Pts) with dysphagia, chest pain (CP), and gastroesophageal reflux disease (GERD), although the clinical utility of EM is unknown.

Methods: Prior to performing EM, referring physicians prospectively completed a questionnaire requesting: primary and secondary indications for the test; primary and secondary symptoms; duration of symptoms; results of previous testing; and medication use. Two weeks after test results were provided to the referring physician, a follow-up questionnaire was sent asking whether EM provided new information, altered the Pt's diagnosis, or changed Pt management. EM were classified using standard criteria. Demographic information was obtained from the Pt.

Results: During a 6 month period, 303 EM were performed and 152 (50.2%) fully completed questionnaires were returned providing data for further analysis. Mean age at time of manometry was 52; 53% were women. Primary reason for requesting EM was dysphagia (33%), followed by the need to accurately place pH probe or BRAVO (29%), acid reflux symptoms (13%), and CP (10%). In the evaluation of their symptoms, 74% of Pts had undergone prior EGD, while 41% underwent barium swallow. Overall, 35% of EM were normal; 22% in dysphagia, 40% in CP, and 25% in GERD. Physicians reported that EM provided new information in 86% of cases for both dysphagia and CP, and 100% of cases for GERD. Results of EM led to a change in diagnosis 48% of the time for dysphagia, 21% of the time for CP, and 20% of the time for GERD. Results of EM led to a change in management 60% of the time for dysphagia, 43% for CP, and 45% of the time for GERD.

Conclusions: EM is a clinically useful test as it frequently provides new information and leads to a change in diagnosis and/or change in management. It is most helpful in patients with the primary complaint of dysphagia.

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