Esophageal Manometry Among Patients With Dysphagia Referred To Kurdistan Center For Gastroenterology And Hepatology

Mohammed O.  Mohammed; Bakhtyar F.  Salim; Ali A.  Ramadhan

doi:10.56056/amj.2015.05

Authors

Mohammed O. Mohammed Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Sulaimani; Kurdistan Center for Gastroenterology and Hepatology, Sulaimani; Iraq.
Bakhtyar F. Salim Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Duhok, Duhok; Kurdistan Center for Gastroenterology and Hepatology, Sulaimani; Iraq
Ali A. Ramadhan Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Duhok, Duhok; Kurdistan Center for Gastroenterology and Hepatology, Sulaimani; Iraq.

DOI:

https://doi.org/10.56056/amj.2015.05

Keywords:

Achalasia, : Dysphagia, KCGH, Manometry

Abstract

Background and Objectives:

Dysphagia is a common problem in patients with primary motor disorders of the esophagus. Esophageal manom- etry is the gold standard for diagnosis of these disorders. Introduction of high resolution manometry represented a significant improvement in data recording and diagnostic yield. The objective of the study was to assess the findings of esophageal high resolution impedance manometry in patients presenting with dysphagia in Sulaimani governorate.

Patients and Methods:

This study extended from September, 2012 to December, 2013 and included 120 patients with dysphagia who were referred for manometry in Kurdistan Center for Gastroenterology and Hepatology (KCGH) in Sulaimani city. All patients underwent upper endoscopy to exclude mechanical and inflammatory causes of dysphagia then the high resolution impedance manometry was used with liquid and viscous swallows.

Results:

The mean age of the study population was 43 years. The female to male ratio was 1.5:1. The mean duration of dysphagia was 2 years. The most common esophageal motility abnormality was achalasia (N=44, 36.7%) followed by hypertensive LES (N=31, 25.8%), ineffective esophageal motility (N=9, 7.5%), hypotensive LES (N=5, 4.2%) and diffuse esophageal spasm (N=3, 2.5%). The high resolution impedance manometry was normal in 28 patients (23.3%). Of the 44 patients with achalasia, 15 patients (34%) had vigorous achalasia. Using Chica- go classification, the most common type of achalasia was type II (N=26, 59%) followed by type I (N=13, 29.6%) and then type III (N=5, 11.4%).

Conclusions:

Esophageal high resolution impedance manometry has an acceptable diagnostic yield in patients with dysphagia.The most common finding is achalasia. Further studies are recommended.

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References

Javle M, Ailawadhi S, Yang GY, Nwogu CE, Schiff MD, Nava HR. Palliation of Malignant Dysphagia in Esophageal Cancer: A Literature-Based Review. J Sup- port Oncol 2006; 4: 365–373.

Kahrilas PJ, Pandolfino JE. Esophageal Neuromus- cular Function and Motility Disorders. In: Feldman M, Friedman LS, Brandt LJ Editors. Sleisenger and Fordtran’s gastrointestinal and liver disease: patho- physiology, diagnosis, management. 9th Ed. Philadel- phia: Elsevier. 2009, PP 677-704.

Massey BT. Esophageal Motor and Sensory Disor- ders: Presentation, Evaluation, and Treatment. Gastro- enterol Clin N Am 2007; 36: 553–575.

Misra A, Chourasia D, Ghoshal UC. Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India. Indian J Gastroenterol 2010; 29(1): 18-22.

Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clin- ical and investigational esophagology. Gastroenterolo- gy 2008; 135: 756-769.

Fox MR, Bredenoord AJ. Oesophageal high-reso- lution manometry: moving from research into clinical practice. Gut 2008; 57(3): 405–423.

Koya DL, Agrawal A, Freeman JE, Castell DO. Im- pedance detected abnormal bolus transit in patients with normal esophageal manometry. Sensitive indica- tor of esophageal functional abnormality? Dis Esopha- gus 2008; 21: 563-569.

Fox M, Hebbard G, Janiak P, Brasseur JG, Ghosh S, Thumshirn M, et al. High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detect- ed by conventional manometry. Neurogastroenterol Motil 2004; 16: 533-542.

Ghosh SK, Pandolfino JE, Zhang Q, Jarosz A, Shah N, Kahrilas PJ. Quantifying esophageal peristalsis with high-resolution manometry: a study of 75 asymptomat- ic volunteers. Am J Physiol Gastrointest Liver Physiol 2006; 290: 988-997.

Clouse RE, Staiano A, Alrakawi A, Haroian, L. Ap- plication of topographical methods to clinical esoph- ageal manometry. Am J Gastroenterol 2000; 95(10): 2720–2730.

Roman S, Pandolfino J, Mion F. High-resolution manometry: a new gold standard to diagnose esopha- geal dysmotility? Gastroenterol Clin Biol 2009; 33(12): 1061-1067.

Vaezi MF, Pandolfino JE, Vela MF. ACG Clinical Guideline: Diagnosis and Management of Achalasia. Am J Gastroenterol 2013; 108 (8): 1238-1249.

Wang A, Pleskow DK, Banerjee S, Barth BA, Bhat YM, Desilets DJ, et al. Esophageal function testing. Gastrointest Endosc 2012; 76 (2): 231-243.

Spechler SJ, Castell DO. Classification of oesoph- ageal motility abnormalities. Gut 2001; 49: 145 – 151.

Tutuian R, Castell DO. Combined multichannel in- traluminal impedance and manometry clarifies esopha- geal function abnormalities: study in 350 patients. Am J Gastroenterol 2004; 99: 1011-1019.

Johnston PW, Johnston BT, Collins BJ, Collins JS,

Love AH. Audit of the role of oesophageal manometry in clinical practice. Gut 1993; 34: 1158-1161.

Pohl D, Tutuian R. Achalasia: an overview of diag- nosis and treatment. J Gastrointestin Liver Dis 2007; 16(3): 297–303.

Dumitra?cu DL, Blaga TS, David L. Esophageal Achalasia – Manometric Patterns. Rom J Intern Med 2009; 47(3): 243–247.

Dekel R., Pearson T, Wendel C, De Garmo P, Fen- nerty MB, Fass R. Assessment of oesophageal motor function in patients with dysphagia or chest pain — the Clinical Outcomes Research Initiative experience. Ali- ment Pharmacol Ther 2003; 18: 1083–1089.

Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology 2010; 139: 369–374.

Carucci LR, Lalani T, Rosen MP, Cash BD, Katz DS, Kim DH, et al. ACR Appropriateness Criteria: dys- phagia. Available from: www.acr.org/~/media/ACR/ Documents/AppCriteria/.../Dysphagia.pdf [Accessed March, 2014].

Salvador R, Costantini M, Zaninotto G, Morbin T, Rizzetto C, Zanatta L, et al. The preoperativemanomet- ric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg 2010; 14: 1635-1645.

Rohof WO, Salvador R, Annese V, Bruley des Va- rannes S, Chaussade S, Costantini M, et al. Outcomes of treatment for achalasia depend on manometric sub- type. Gastroenterology 2013; 144: 718-725.

Gad El-Hak NA, Mostafa M, AbdelHamid H, Hal- eem M. Hypertensive Lower Esophageal Sphincter (HLES): Prevalence, Symptoms Genesis and Effect of Pneumatic Balloon Dilatation. Saudi J Gastroenterol 2006; 12(2): 77-82.

Bodger K, Trudgill N. BSG Guidelines in Gastroen- terology: Guidelines for oesophageal manometry and pH monitoring. 2006 Available from: www.bsg.org.uk/ pdf_word_docs/oesp_man.pdf. [accessed July, 2012].

Prabhakar A, Levine MS, Rubesin S, Laufer I, Katzka D. Relationship Between Diffuse Esophageal Spasm and Lower Esophageal Sphincter Dysfunction on Barium Studies and Manometry in 14 Patients. Am J Roentgenol 2004; 183(2): 409-413.

Pandolfino JE, Kahrilas PJ. AGA Technical Re- view on the Clinical Use of Esophageal Manometry. Gastroenterology 200