Clinical characteristics of absent contractility and ineffective esophageal motility: a multicenter study in Japan.
esophageal achalasia
esophageal motility
gastroesophageal reflux
manometry
scleroderma
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
04
04
2023
received:
11
12
2022
accepted:
06
06
2023
medline:
27
11
2023
pubmed:
1
7
2023
entrez:
30
6
2023
Statut:
ppublish
Résumé
Absent contractility (AC) and ineffective esophageal motility (IEM) are esophageal hypomotility disorders diagnosed using high-resolution manometry (HRM). Patient characteristics and disease course of these conditions and differential diagnosis between AC and achalasia are yet to be elucidated. A multicenter study involving 10 high-volume hospitals was conducted. Starlet HRM findings were compared between AC and achalasia. Patient characteristics including underlying disorders and disease courses were analyzed in AC and IEM. Fifty-three patients with AC and 92 with IEM were diagnosed, while achalasia was diagnosed in 1784 patients using the Chicago classification v3.0 (CCv3.0). The cut-off integrated relaxation pressure (IRP) value at 15.7 mmHg showed maximum sensitivity (0.80) and specificity (0.87) for differential diagnosis of AC from type I achalasia. While most ACs were based on systemic disorders such as scleroderma (34%) and neuromuscular diseases (8%), 23% were sporadic cases. The symptom severity of AC was not higher than that of IEM. Regarding the diagnosis of IEM, the more stringent CCv4.0 excluded 14.1% of IEM patients than the CCv3.0, although patient characteristics did not change. In patients with the hypomotile esophagus, concomitance of reflux esophagitis was associated with low distal contractile integral and IRP values. AC and IEM transferred between each other, paralleling with the underlying disease course, although no transition to achalasia was observed. A successful determination of the optimal cut-off IRP value was achieved using the starlet HRM system to differentiate AC and achalasia. Follow-up HRM is also useful for differentiating AC from achalasia. Symptom severity may depend on underlying diseases instead of hypomotility severity.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Absent contractility (AC) and ineffective esophageal motility (IEM) are esophageal hypomotility disorders diagnosed using high-resolution manometry (HRM). Patient characteristics and disease course of these conditions and differential diagnosis between AC and achalasia are yet to be elucidated.
METHODS
METHODS
A multicenter study involving 10 high-volume hospitals was conducted. Starlet HRM findings were compared between AC and achalasia. Patient characteristics including underlying disorders and disease courses were analyzed in AC and IEM.
RESULTS
RESULTS
Fifty-three patients with AC and 92 with IEM were diagnosed, while achalasia was diagnosed in 1784 patients using the Chicago classification v3.0 (CCv3.0). The cut-off integrated relaxation pressure (IRP) value at 15.7 mmHg showed maximum sensitivity (0.80) and specificity (0.87) for differential diagnosis of AC from type I achalasia. While most ACs were based on systemic disorders such as scleroderma (34%) and neuromuscular diseases (8%), 23% were sporadic cases. The symptom severity of AC was not higher than that of IEM. Regarding the diagnosis of IEM, the more stringent CCv4.0 excluded 14.1% of IEM patients than the CCv3.0, although patient characteristics did not change. In patients with the hypomotile esophagus, concomitance of reflux esophagitis was associated with low distal contractile integral and IRP values. AC and IEM transferred between each other, paralleling with the underlying disease course, although no transition to achalasia was observed.
CONCLUSION
CONCLUSIONS
A successful determination of the optimal cut-off IRP value was achieved using the starlet HRM system to differentiate AC and achalasia. Follow-up HRM is also useful for differentiating AC from achalasia. Symptom severity may depend on underlying diseases instead of hypomotility severity.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1926-1933Subventions
Organisme : JGA Clinical Research Grants
ID : 2021-1
Informations de copyright
© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Patel DA, Yadlapati R, Vaezi MF. Esophageal motility disorders: current approach to diagnostics and therapeutics. Gastroenterology 2022; 162: 1617-1634.
Kahrilas PJ, Bredenoord AJ, Fox M et al. The Chicago classification of esophageal motility disorders. v.3.0. Neurogastroenterol Motil; 2015;27. p. 160-74.
Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol 2014; 109: 46-51.
Delay K, Krause A, Yadlapati R. Clinical updates in esophageal motility disorders beyond achalasia. Clin Gastroenterol Hepatol 2021; 19: 1789-1792.e1.
Crowell MD, Umar SB, Griffing WL, DiBaise JK, Lacy BE, Vela MF. Esophageal motor abnormalities in patients with scleroderma: heterogeneity, risk factors, and effects on quality of life. Clin Gastroenterol Hepatol 2017; 15: 207-213.e1.
Sallam H, McNearney TA, Chen JDZ. Systematic review: pathophysiology and management of gastrointestinal dysmotility in systemic sclerosis (scleroderma). Aliment Pharmacol Ther 2006; 23: 691-712.
Sato H, Hasegawa G, Yokoyama J et al. Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology. J Gastroenterol 2018; 53: 484-493.
Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med 1997; 336: 924-932.
Ponds FA, Bredenoord AJ, Kessing BF, Smout AJ. Esophagogastric junction distensibility identifies achalasia subgroup with manometrically normal esophagogastric junction relaxation. Neurogastroenterol Motil 2017; 29: 1-8.
Tatsuta T, Sato H, Fujiyoshi Y et al. Subtype of achalasia and integrated relaxation pressure measured using the Starlet high-resolution manometry system: a multicenter study in Japan. J Neurogastroenterol Motil 2022; 28: 562-571.
Yadlapati R, Kahrilas PJ, Fox MR et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil 2021; 33: e14058.
Sato H, Yokomichi H, Takahashi K et al. Epidemiological analysis of achalasia in Japan using a large-scale claims database. J Gastroenterol 2019; 54: 621-627.
Nakamura J, Sato H, Onimaru M et al. Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery-Japan achalasia multicenter study. Dig Endosc 2022 Epub ahead of print; 34(7): 1394-1402.
Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 2001; 11: 281-292.
Kuribayashi S, Iwakiri K, Shinozaki T et al. Clinical impact of different cut-off values in high-resolution manometry systems on diagnosing esophageal motility disorders. J Gastroenterol 2019; 54: 1078-1082.
Jones R, Junghard O, Dent J et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009; 30: 1030-1038.
Kovacs B, Masuda T, Bremner RM, Mittal SK. Clinical spectrum and presentation of patients with absent contractility. Ann Gastroenterol 2021; 34: 331-336.
Kuribayashi S, Motegi SI, Hara K et al. Relationship between esophageal motility abnormalities and skin or lung involvements in patients with systemic sclerosis. J Gastroenterol 2019; 54: 950-962.
Alcalá-González LG, Jimenez-Masip A, Relea-Pérez L, Barber-Caselles C, Barba-Orozco E. Underlying etiology associated with the diagnosis of absent contractility on high resolution esophageal manometry. Gastroenterol Hepatol 2023; 46: 10-16.
Sato H, Takahashi K, Mizuno KI et al. Overlap in disease concept of functional esophageal disorders and minor esophageal motility disorders. J Gastroenterol Hepatol 2019; 34: 1940-1945.
Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Functional esophageal disorders. Gastroenterology 2016; 150: 1368-1379.
Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with dysphagia. Am J Gastroenterol 2011; 106: 349-356.
Ravi K, Friesen L, Issaka R, Kahrilas PJ, Pandolfino JE. Long-term outcomes of patients with normal or minor motor function abnormalities detected by high-resolution esophageal manometry. Clin Gastroenterol Hepatol 2015; 13: 1416-1423.
Rogers BD, Rengarajan A, Mauro A et al. Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows. Neurogastroenterol Motil 2020; 32: e13736.
Fornari F, Bravi I, Penagini R, Tack J, Sifrim D. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil 2009; 21: 718-e41.