Compartmentalized pressurization is a novel prognostic factor for hypercontractile esophagus.
compartmentalized pressurization
endoscopic functional lumen imaging probe
esophageal motility disorders
high-resolution manometry
hypercontractile esophagus
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
20 Nov 2023
20 Nov 2023
Historique:
revised:
21
10
2023
received:
29
07
2023
accepted:
30
10
2023
medline:
20
11
2023
pubmed:
20
11
2023
entrez:
20
11
2023
Statut:
aheadofprint
Résumé
Hypercontractile esophagus (HE) is a disorder of increased esophageal body contractile strength on high-resolution esophageal manometry (HREM). Compartmentalized pressurization (CP) is a pattern with an isobaric contour of >30 mmHg extending from the contractile front to the lower esophageal sphincter on HREM. The relevance of CP to HE has yet to be explored. A retrospective review was performed on 830 HREM studies of patients to identify HE. HE patients' CP status and symptoms by Eckardt score (ES) were reviewed. Diagnoses were made using Chicago Classification (CC) v4.0. Forty-seven patients (5.6%) were identified as having HE by CCv3, 30 (3.6%) of which had HE by CCv4. 11/30 HE patients had CP, and 19/30 did not. CP was associated with chronic opioid use (36.4% vs. 5.3% p = 0.047). Presenting ES was greater for HE patients with CP (7 vs. 4). Seven HE patients with CP and 11 without CP were managed medically. ES after medical therapy was higher in HE patients with CP compared to those without CP (9 vs. 0). No HE patients with CP responded to medical therapy. Kaplan-Meier analysis demonstrated significance of this association over time. 83% of all HE patients had all-cause symptom remission. HE patients with CP are associated with a higher presenting ES. HE patients with CP do not respond to medical therapy, while HE patients without CP frequently do respond. CP in HE may have prognostic value in determination of treatment strategy for patients with HE.
Sections du résumé
BACKGROUND
BACKGROUND
Hypercontractile esophagus (HE) is a disorder of increased esophageal body contractile strength on high-resolution esophageal manometry (HREM). Compartmentalized pressurization (CP) is a pattern with an isobaric contour of >30 mmHg extending from the contractile front to the lower esophageal sphincter on HREM. The relevance of CP to HE has yet to be explored.
METHODS
METHODS
A retrospective review was performed on 830 HREM studies of patients to identify HE. HE patients' CP status and symptoms by Eckardt score (ES) were reviewed. Diagnoses were made using Chicago Classification (CC) v4.0.
KEY RESULTS
RESULTS
Forty-seven patients (5.6%) were identified as having HE by CCv3, 30 (3.6%) of which had HE by CCv4. 11/30 HE patients had CP, and 19/30 did not. CP was associated with chronic opioid use (36.4% vs. 5.3% p = 0.047). Presenting ES was greater for HE patients with CP (7 vs. 4). Seven HE patients with CP and 11 without CP were managed medically. ES after medical therapy was higher in HE patients with CP compared to those without CP (9 vs. 0). No HE patients with CP responded to medical therapy. Kaplan-Meier analysis demonstrated significance of this association over time. 83% of all HE patients had all-cause symptom remission.
CONCLUSIONS & INFERENCES
CONCLUSIONS
HE patients with CP are associated with a higher presenting ES. HE patients with CP do not respond to medical therapy, while HE patients without CP frequently do respond. CP in HE may have prognostic value in determination of treatment strategy for patients with HE.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14711Subventions
Organisme : US National institutes of Health
ID : T32 DK067872-19
Informations de copyright
© 2023 John Wiley & Sons Ltd.
Références
Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21(8):796-806.
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0((c)). Neurogastroenterol Motil. 2021;33(1):e14058.
Clement M, Zhu WJ, Neshkova E, Bouin M. Jackhammer esophagus: from manometric diagnosis to clinical presentation. Can J Gastroenterol Hepatol. 2019;2019:5036160.
Wahba G, Bouin M. Jackhammer esophagus: a meta-analysis of patient demographics, disease presentation, high-resolution manometry data, and treatment outcomes. Neurogastroenterol Motil. 2020;32(11):e13870.
Xiao Y, Carlson DA, Lin Z, Alhalel N, Pandolfino JE. Jackhammer esophagus: assessing the balance between prepeak and postpeak contractile integral. Neurogastroenterol Motil. 2018;30(5):e13262.
Roman S, Pandolfino JE, Chen J, Boris L, Luger D, Kahrilas PJ. Phenotypes and clinical context of hypercontractility in high-resolution esophageal pressure topography (EPT). Am J Gastroenterol. 2012;107(1):37-45.
Hong YS, Min YW, Rhee PL. Two distinct types of hypercontractile esophagus: classic and spastic jackhammer. Gut Liver. 2016;10(5):859-863.
Kahn A, Al-Qaisi MT, Obeid RA, et al. Clinical features and long-term outcomes of lower esophageal sphincter-dependent and lower esophageal sphincter-independent jackhammer esophagus. Neurogastroenterol Motil. 2019;31(2):e13507.
Song BG, Min YW, Lee H, et al. Clinicomanometric factors associated with clinically relevant esophagogastric junction outflow obstruction from the sandhill high-resolution manometry system. Neurogastroenterol Motil. 2018;30(3):e13221.
ZVU Guide. High resolution esophageal manometry analysis. 2020. Accessed January 14, 2023. https://www.diversatekhealthcare.com/wp-content/uploads/2020/10/080-0063-Zvu-Guide-High-Resolution-Esophageal-Manometry-Analysis-Guide.pdf
Leopold AR, Jalalian A, Thaker P, Wellington J, Papademetriou M, Xie G. Major mixed motility disorders: an important subset of esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2023;35:e14555.
Madigan KE, Smith JS, Evans JK, Clayton SB. Elevated average maximum intrabolus pressure on high-resolution manometry is associated with esophageal dysmotility and delayed esophageal emptying on timed barium esophagram. BMC Gastroenterol. 2022;22(1):74.
van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015;27(9):1310-1316.
Niebisch S, Wilshire CL, Peters JH. Systematic analysis of esophageal pressure topography in high-resolution manometry of 68 normal volunteers. Dis Esophagus. 2013;26(7):651-660.
Triggs JR, Carlson DA, Beveridge C, Kou W, Kahrilas PJ, Pandolfino JE. Functional luminal imaging probe panometry identifies achalasia-type esophagogastric junction outflow obstruction. Clin Gastroenterol Hepatol. 2020;18(10):2209-2217.
Beveridge CA, Triggs JR, Thanawala SU, et al. Can FLIP guide therapy in idiopathic esophagogastric junction outflow obstruction? Dis Esophagus. 2022;35(4):1-7.
Carlson DA, Schauer JM, Kou W, Kahrilas PJ, Pandolfino JE. Functional lumen imaging probe panometry helps identify clinically relevant esophagogastric junction outflow obstruction per Chicago classification v4.0. Am J Gastroenterol. 2023;118(1):77-86.
Carlson DA, Baumann AJ, Prescott JE, et al. Validation of secondary peristalsis classification using FLIP panometry in 741 subjects undergoing manometry. Neurogastroenterol Motil. 2022;34(1):e14192.
Snyder DL, Crowell MD, Horsley-Silva J, Ravi K, Lacy BE, Vela MF. Opioid-induced esophageal dysfunction: differential effects of type and dose. Am J Gastroenterol. 2019;114(9):1464-1469.
Mallet AL, Ropert A, Bouguen G, et al. Prevalence and characteristics of acid gastro-oesophageal reflux disease in jackhammer oesophagus. Dig Liver Dis. 2016;48(10):1136-1141.
Eherer AJ, Schwetz I, Hammer HF, et al. Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders. Gut. 2002;50(6):758-764.
Pimentel M, Bonorris GG, Chow EJ, Lin HC. Peppermint oil improves the manometric findings in diffuse esophageal spasm. J Clin Gastroenterol. 2001;33(1):27-31.
Cattau EL Jr, Castell DO, Johnson DA, et al. Diltiazem therapy for symptoms associated with nutcracker esophagus. Am J Gastroenterol. 1991;86(3):272-276.
Clouse RE, Lustman PJ, Eckert TC, Ferney DM, Griffith LS. Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial. Gastroenterology. 1987;92(4):1027-1036.
Viazis N, Keyoglou A, Kanellopoulos AK, et al. Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study. Am J Gastroenterol. 2012;107(11):1662-1667.
Schupack D, Katzka DA, Geno DM, Ravi K. The clinical significance of esophagogastric junction outflow obstruction and hypercontractile esophagus in high resolution esophageal manometry. Neurogastroenterol Motil. 2017;29(10):1-9.
Marjoux S, Brochard C, Roman S, et al. Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may high-resolution manometry help to select cases? Dis Esophagus. 2015;28(8):735-741.
Mion F, Marjoux S, Subtil F, et al. Botulinum toxin for the treatment of hypercontractile esophagus: results of a double-blind randomized sham-controlled study. Neurogastroenterol Motil. 2019;31(5):e13587.
Canakis A, Xie G, Kim RE. Peroral endoscopic myotomy is an effective treatment option for managing jackhammer esophagus: a single center experience. J Clin Gastroenterol. 2022;57:569-573.
Albers D, Frieling T, Dakkak D, et al. Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM-HYPE-study. Z Gastroenterol. 2018;56(11):1337-1342.
Filicori F, Dunst CM, Sharata A, et al. Long-term outcomes following POEM for non-achalasia motility disorders of the esophagus. Surg Endosc. 2019;33(5):1632-1639.
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732-1738.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-174.
Triggs JR, Carlson DA, Beveridge C, et al. Upright integrated relaxation pressure facilitates characterization of esophagogastric junction outflow obstruction. Clin Gastroenterol Hepatol. 2019;17(11):2218-2226.
Clouse RE, Staiano A, Alrakawi A. Topographic analysis of esophageal double-peaked waves. Gastroenterology. 2000;118(3):469-476.
Chen JW, Savarino E, Smout A, et al. Chicago classification update (v4.0): technical review on diagnostic criteria for hypercontractile esophagus. Neurogastroenterol Motil. 2021;33(6):e14115.
Quader F, Mauro A, Savarino E, et al. Jackhammer esophagus with and without esophagogastric junction outflow obstruction demonstrates altered neural control resembling type 3 achalasia. Neurogastroenterol Motil. 2019;31(9):e13678.
Carlson DA, Kahrilas PJ, Lin Z, et al. Evaluation of esophageal motility utilizing the functional lumen imaging probe. Am J Gastroenterol. 2016;111(12):1726-1735.
Ichkhanian Y, Sanaei O, Canakis A, et al. Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial. Endosc Int Open. 2020;8(9):E1137-E1143.
Min YW, Jung KW, Jung K, Cho YK, Park MI, Dysphagia Study Group Under the Korean Society of Neurogastroenterology and Motility. Hypercontractile esophagus: clinical and manometric features from a multicenter Korean cohort. J Neurogastroenterol Motil. 2023;29(2):166-173.
Jacobs CC, Al-Haddad M, Stainko S, Perkins A, DeWitt JM. Prevalence and impact of opioid use in patients undergoing peroral endoscopic myotomy. Gastrointest Endosc. 2023;97(4):655-663.