Ineffective esophageal motility and bolus clearance. A study with combined high-resolution manometry and impedance in asymptomatic controls and patients
Por:
Zerbib, F, Marin, I, Cisternas, D, Abrahao, L, Hani, A, Leguizamo, AM, Remes-Troche, JM, de la Serna, JP, de Leon, AR and Serra, J
Publicada:
1 sep 2020
Ahead of Print:
1 may 2020
Resumen:
Background The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance.
Methods To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high-resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients' customary symptoms.
Key Results In asymptomatic controls, the normal range of swallows with CBT was 50%-100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions (P < .001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions >= 30% (specificity 88.2% and sensitivity of 84.6%), and >= 70% ineffective (failed + weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores.
Conclusions and Inferences Based on bolus clearance assessed by HRIM, >= 30% failed contractions and >= 70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.
Filiaciones:
Zerbib, F:
Autonomous Univ Barcelona, Univ Hosp Germans Trias & Pujol, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Motil & Funct Gut Disorders Unit,Dept Med, Badalona, Spain
Univ Bordeaux, Hop Haut Leveque, Ctr Medicochirurg Magellan, Gastroenterol Dept,CHU Bordeaux,INSERM CIC 1401, Bordeaux, France
:
Autonomous Univ Barcelona, Univ Hosp Germans Trias & Pujol, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Motil & Funct Gut Disorders Unit,Dept Med, Badalona, Spain
Cisternas, D:
Univ Desarrollo, Fac Med, Clin Alemana Santiago, Santiago, Chile
Abrahao, L:
Univ Hosp Clementino Fraga Filho, Rio De Janeiro, Brazil
Hani, A:
Pontificia Univ Javeriana, Hosp Univ San Ignacio, Dept Gastroenterol, Bogota, Colombia
Pontificia Univ Javeriana, Hosp Univ San Ignacio, Lab Motilidad, Bogota, Colombia
Leguizamo, AM:
Pontificia Univ Javeriana, Hosp Univ San Ignacio, Dept Gastroenterol, Bogota, Colombia
Pontificia Univ Javeriana, Hosp Univ San Ignacio, Lab Motilidad, Bogota, Colombia
Remes-Troche, JM:
Univ Veracruzana, Inst Invest Med Biol, Xalapa, Veracruz, Mexico
de la Serna, JP:
Clin San Carlos Hosp, Madrid, Spain
de Leon, AR:
Clin San Carlos Hosp, Madrid, Spain
:
Autonomous Univ Barcelona, Univ Hosp Germans Trias & Pujol, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Motil & Funct Gut Disorders Unit,Dept Med, Badalona, Spain
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