Original article
Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry

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Abstract

Background & Aims: Combined multichannel intraluminal impedance (MII) and manometry (MII-EM) recently became available as an esophageal function test. Initial studies in healthy volunteers have shown that a proportion of ineffective contractions actually have complete bolus transit. The aim of our study is to evaluate esophageal bolus transit in patients with manometric patterns of ineffective esophageal motility (IEM). Methods: All patients referred for esophageal function testing during a 9-month period underwent combined MII-EM studies, including 10 liquid and 10 viscous swallows. IEM is defined as ≥30% liquid swallows with contraction amplitude <30 mm Hg in the distal esophagus. Diagnosis of esophageal transit abnormalities is defined as abnormal bolus transit if ≥30% of liquid and ≥40% of viscous swallows had incomplete bolus transit. Results: Seventy patients (35 women; mean age, 54 yr; range, 17–86 yr) with a manometric diagnosis of IEM were identified of a total of 350 combined MII-EM studies. In these patients, 68% of liquid and 59% of viscous swallows showed normal bolus transit, and almost one third of patients received an overall diagnosis of normal bolus transit for both liquid and viscous swallows. Conclusions: Our experience with combined MII-EM in patients with a manometric diagnosis of IEM confirms the suspicion that “effectiveness” should only be determined by using a test of esophageal function. Furthermore, we believe our results support a conclusion that a higher level of esophageal diagnostic information is best obtained by combined MII-EM. Future outcome studies should establish its value in patients with nonobstructive dysphagia and in prefundoplication assessment.

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Materials and methods

Since Food and Drug Administration approval of the technique of MII-EM in July 2002, all patients referred to our laboratory have undergone esophageal function testing using this technique. Approval for publishing information from esophageal function testing using combined MII-EM was obtained from the Institutional Review Board of the Medical University of South Carolina (Charleston, SC). All patients included in this study provided informed consent giving the investigators permission to use

Results

Seventy patients (35 women, 35 men; mean age, 54 yr; range, 17–86 yr) with a manometric diagnosis of IEM were identified from a total of 350 MII-EM studies between July 1, 2002, and March 31, 2003. Esophageal function testing was performed as either a primary diagnostic procedure or before ambulatory pH monitoring. The major symptom for which patients were referred was heartburn (41.4%), dysphagia (28.5%), chronic cough (10%), chest pain (7.1%), hoarseness (5.7%), regurgitation (5.7%), and

Discussion

We report on direct measurement of both esophageal pressures and bolus movement by using combined MII-EM technology in 70 patients with a manometric pattern consistent with the diagnosis of IEM. Interestingly, results are almost identical to those observed in a recent multicenter study of 43 healthy volunteers in which manometric ineffective contractions (<30 mm Hg) were shown to have complete bolus transit of liquid and viscous material in 48% and 34% of swallows, respectively.8 In the 70

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