High-resolution manometry alters the diagnosis

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Gut

2011;60:A152-A153

doi:10.1136/gut.2011.239301.323

Posters

Neurogastroenterology/motility

High-resolution manometry alters the diagnosis in

patients diagnosed with diffuse oesophageal spasm by conventional manometry:

resurgence of achalasia cardia

http://gut.bmj.com/content/60/Suppl_1/A152.2.abstract?ct=ct

D Majumdar *1,

P Saunders2,

Y Yiannakou3,

A Dhar1- Author Affiliations

1Gastroenterology, County Durham & Darlington NHS

Foundation Trust, Durham, UK

2Medical Physics, County Durham & Darlington

NHS Foundation Trust, Durham, UK

3Gastroenterology, County Durham & Darlington

NHS Foundation Trust, Durham, UK

Abstract

Introduction

Oesophageal manometry is the gold standard for the diagnosis of

oesophageal dysmotility, a common clinical problem. Advances

in manometric techniques by

high-resolution manometry (HRM) and oesophageal pressure topography have

revolutionised the interpretation

of oesophageal physiology. There are

reports of the impact of HRM to a change in manometric diagnosis.

Aim To study the change in the diagnosis of

diffuse oesophageal spasm by HRM and its impact on clinical management of

oesophageal

dysmotility.

Patients and methods

Between 2009 and 2010, all patients with a diagnosis of diffuse

oesophageal spasm on conventional manometry referred for

endoscopic botulinum toxin treatment

were offered HRM at a tertiary referral centre. Case notes review was

done for clinical

symptoms at presentation, initial

and final manometric diagnosis and outcomes of treatment.

Results 10

patients were referred for botulinum toxin treatment of diffuse

oesophageal spasm. Presenting symptoms were dysphagia,

chest pain, regurgitation and weight

loss; 6 patients had more than one symptom. Mean age = 57.6 years with

M: F = 1:2. Mean

duration between onset of symptoms

and referral to specialist service was 20.6 months. All had a normal

gastroduodenoscopy.

Seven patients had barium swallow

showing: hiatus hernia (n=1), oesophageal dysmotility (n=3), probable

achalasia (n=2) and

normal study (n=1). On conventional

manometry, 7 were diagnosed as diffuse oesophageal spasm (DES), 2 were

diagnosed with

hypertensive oesophageal

contractions and one had diffuse dysmotility. Five of these patients had

HRM at a tertiary centre.

Three patients had features of

classic achalasia, one revealed DES and one had functional

oesophago-gastric junction (OGJ)

obstruction. The patients with

achalasia were treated with 100 units of Botulinum toxin injection at

the OG junction. 2 of

them had complete symptom resolution

and remained symptom free at 1 year follow-up. 1 patient with achalasia

did not respond

and was referred for a laparoscopic

cardiomyotomy. Of the 5 patients with DES and hypertensive contractions 2

were treated

successfully with Botulinum toxin

injection to the OG junction and in the lower body of oesophagus. 3

patients had calcium

channel blocker therapy with good

symptom resolution.

Conclusion

HRM alters the diagnosis of diffuse oesophageal spasm on conventional

manometry to achalasia in a third of patients, and

therefore has a significant impact

on their treatment options. Based on this initial observation, a larger

prospective study

is planned to investigate this

change to diagnosis.

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