BACKGROUND: Integrated relaxation pressure (IRP) is a key metric for diagnosing esophagogastric junction outflow obstruction (EGJOO). However, its normal value might be different according to the manufacturer of high-resolution manometry (HRM). This study aimed to investigate optimal value of IRP for diagnosing EGJOO in Sandhill HRM and to find clinicomanometric variables to segregate clinically relevant EGJOO. METHODS: We analyzed 262 consecutive subjects who underwent HRM between June 2011 and December 2016 showing elevated median IRP (> 15 mm Hg) but did not satisfy criteria for achalasia. Clinically relevant subjects were defined as follows: (i) subsequent HRM met achalasia criteria during follow-up (early achalasia); (ii) Eckardt score was decreased at least two points without exceeding a score of 3 after pneumatic dilatation (variant achalasia); and (iii) significant passage disturbance on esophagogram without structural abnormality (possible achalasia). KEY RESULTS: Seven subjects were clinically relevant, including two subjects with early achalasia, four subjects with variant achalasia, and one subject with possible achalasia. All clinically relevant subjects had IRP 20 mm Hg or above. Among subjects (n = 122) with IRP 20 mm Hg or more, clinically relevant group (n = 7) had significantly higher rate of dysphagia (100% vs 24.3%, P < .001) and compartmentalized pressurization (85.7% vs 21.7%, P = .001) compared to clinically non-relevant group (n = 115). CONCLUSIONS & INFERENCES: Our results suggest that IRP of 20 mm Hg or higher could segregate clinically relevant subjects showing EGJOO in Sandhill HRM. Additionally, if subjects have both dysphagia and compartmentalized pressurization, careful follow-up is essential.
BACKGROUND: Integrated relaxation pressure (IRP) is a key metric for diagnosing esophagogastric junction outflow obstruction (EGJOO). However, its normal value might be different according to the manufacturer of high-resolution manometry (HRM). This study aimed to investigate optimal value of IRP for diagnosing EGJOO in Sandhill HRM and to find clinicomanometric variables to segregate clinically relevant EGJOO. METHODS: We analyzed 262 consecutive subjects who underwent HRM between June 2011 and December 2016 showing elevated median IRP (> 15 mm Hg) but did not satisfy criteria for achalasia. Clinically relevant subjects were defined as follows: (i) subsequent HRM met achalasia criteria during follow-up (early achalasia); (ii) Eckardt score was decreased at least two points without exceeding a score of 3 after pneumatic dilatation (variant achalasia); and (iii) significant passage disturbance on esophagogram without structural abnormality (possible achalasia). KEY RESULTS: Seven subjects were clinically relevant, including two subjects with early achalasia, four subjects with variant achalasia, and one subject with possible achalasia. All clinically relevant subjects had IRP 20 mm Hg or above. Among subjects (n = 122) with IRP 20 mm Hg or more, clinically relevant group (n = 7) had significantly higher rate of dysphagia (100% vs 24.3%, P < .001) and compartmentalized pressurization (85.7% vs 21.7%, P = .001) compared to clinically non-relevant group (n = 115). CONCLUSIONS & INFERENCES: Our results suggest that IRP of 20 mm Hg or higher could segregate clinically relevant subjects showing EGJOO in Sandhill HRM. Additionally, if subjects have both dysphagia and compartmentalized pressurization, careful follow-up is essential.
Authors: Claire A Beveridge; Joseph R Triggs; Shivani U Thanawala; Nitin K Ahuja; Gary W Falk; Alain J Benitez; Kristle L Lynch Journal: Dis Esophagus Date: 2022-04-19 Impact factor: 2.822
Authors: Rena Yadlapati; Peter J Kahrilas; Mark R Fox; Albert J Bredenoord; C Prakash Gyawali; Sabine Roman; Arash Babaei; Ravinder K Mittal; Nathalie Rommel; Edoardo Savarino; Daniel Sifrim; André Smout; Michael F Vaezi; Frank Zerbib; Junichi Akiyama; Shobna Bhatia; Serhat Bor; Dustin A Carlson; Joan W Chen; Daniel Cisternas; Charles Cock; Enrique Coss-Adame; Nicola de Bortoli; Claudia Defilippi; Ronnie Fass; Uday C Ghoshal; Sutep Gonlachanvit; Albis Hani; Geoffrey S Hebbard; Kee Wook Jung; Philip Katz; David A Katzka; Abraham Khan; Geoffrey Paul Kohn; Adriana Lazarescu; Johannes Lengliner; Sumeet K Mittal; Taher Omari; Moo In Park; Roberto Penagini; Daniel Pohl; Joel E Richter; Jordi Serra; Rami Sweis; Jan Tack; Roger P Tatum; Radu Tutuian; Marcelo F Vela; Reuben K Wong; Justin C Wu; Yinglian Xiao; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-01 Impact factor: 3.598