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. 2018 Oct;52(9):e73-e81.
doi: 10.1097/MCG.0000000000000949.

Roles of High-resolution Manometry in Predicting Incomplete Bolus Transit in Patients With Dysphagia

Zhaohong Shi  1   2 , Jie Guo  1   2 , John Clarke  1 , Haifeng Jin  1   3 , Xinjun Wang  1 , Nina Zhang  1 , Ellen Stein  1 , Sameer Dhalla  1 , Pankaj J Pasricha  1 , Jiande D Z Chen  1
Affiliations

Roles of High-resolution Manometry in Predicting Incomplete Bolus Transit in Patients With Dysphagia

Zhaohong Shi et al. J Clin Gastroenterol. 2018 Oct.

Abstract

Background: High-resolution manometry (HRM) is used to assess esophageal motility diseases. Abnormalities in a number of HRM parameters have been reported in patients with dysphagia. However, it is unclear whether some of abnormal HRM parameters are predictive of dysphagia. The aim of this retrospective study was to investigate the roles of HRM parameters in predicting incomplete bolus clearance (IBC) in patients with dysphagia using high-resolution impedance manometry.

Methods: A total of 644 wet swallows were reviewed and analyzed in 63 patients with symptoms of dysphagia or reflux who underwent a clinical high-resolution impedance manometry test. IBC was defined based on impedance measurement. The relationship of each of abnormal HRM parameters with IBC was analyzed and their roles in predicting IBC were determined.

Results: Patients with symptoms of both dysphagia and reflux showed the highest IBC rate, and patients with symptoms of reflux had the lowest IBC rate. The IBC was more prevalent in the distal esophagus. Premature contractions and peristalsis with large breaks were associated with a higher IBC rate in the proximal esophagus (P<0.05); large breaks, ineffective peristalsis, and abnormalities of the esophageal gastric junction functions were associate with higher IBC rates in the distal esophagus (P<0.05). Abnormalities in a number of motility parameters were able to predict IBC with high specificities and/or high sensitivity, such as pan esophageal pressurization, ineffective peristalsis, and large breaks. Abnormal integrative relaxation pressure of the lower esophageal sphincter with concurrent pan esophageal pressurization, ineffective peristalsis, or large breaks is predictive of IBC with nearly 100% of specificity.

Conclusions: Abnormalities in a number of HRM parameters are not only useful in diagnosing esophageal motility diseases, but also valuable in predicting IBC during swallowing.

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Figures

FIGURE 1.
FIGURE 1.
EPT and impedance tracings in HRIM study. A, Example of intact peristalsis associated with complete bolus clearance. Impedance tracings are superimposed to EPT and impedance data are also displayed by overlaid pink colorization. The pink shaded area indicates bolus presence. Complete bolus clearance was observed with the onset of contraction at each esophageal level corresponding to the clearance of pink colorization and the upward inflection in the impedance tracings. B, Example of weak peristalsis associated with IBC in proximal esophagus. C, Example of weak peristalsis associated with IBC in distal esophagus. D, Example of ineffective peristalsis (weak contraction and reduced DL) plus with abnormal IRP (> 15 mm Hg) associated with IBC in the whole esophagus. DL indicates distal latency;EPT, esophageal pressure topography;HRIM, high-resolution impedance manometry;IBC, incomplete bolus clearance;IRP, integrated relaxation pressure.
FIGURE 2.
FIGURE 2.
Incomplete bolus clearance rate in the proximal and distal esophagus of patients with different symptoms (dysphagia, reflux, or dysphagia and reflux). *P < 0.05 versus proximal; #P < 0.05 versus proximal esophagus of patients with symptoms of reflux; &P < 0.05 versus distal esophagus of patients with symptoms of reflux.
FIGURE 3.
FIGURE 3.
ROC analysis of using IRP, ineffective peristalsis, and DCI to predict incomplete bolus transit. DCI indicates distal contractile integral;IRP, integrated relaxation pressure;ROC, receiver operating characteristic.
See this image and copyright information in PMC

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