Dustin A Carlson1, Alexandra J Baumann1, Jacqueline E Prescott1, Erica N Donnan1, Rena Yadlapati2, Abraham Khan3, C Prakash Gyawali4, Wenjun Kou1, Peter J Kahrilas1, John E Pandolfino1. 1. Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 2. Division of Gastroenterology, San Diego School of Medicine, University of California, La Jolla, CA, USA. 3. Division of Gastroenterology, New York University School of Medicine, New York, NY, USA. 4. Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
Abstract
BACKGROUND AND AIMS: This study aimed to systematically evaluate a classification scheme of secondary peristalsis using functional luminal imaging probe (FLIP) panometry through comparison with primary peristalsis on high-resolution manometry (HRM). METHODS: 706 adult patients that completed FLIP and HRM for primary esophageal motility evaluation and 35 asymptomatic volunteers ("controls") were included. Secondary peristalsis, that is, contractile responses (CRs), was classified on FLIP panometry by the presence and pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), absent (ACR), or spastic-reactive (SRCR). Primary peristalsis on HRM was assessed according to the Chicago Classification. RESULTS: All 35 of the controls had antegrade contractions on FLIP panometry with either NCR (89%) or BCR (11%). The average percentages of normal swallows on HRM varied across contractile response patterns from 84% in NCR, 68% in BCR, 39% in IDCR, to 11% in ACR, as did the percentage of failed swallows on HRM: 4% in NCR, 12% in BCR, 36% in IDCR, and 79% in ACR. SRCR on FLIP panometry was observed in 18/57 (32%) patients with type III achalasia, 4/15 (27%) with distal esophageal spasm, and 7/15 (47%) with hypercontractile esophagus on HRM. CONCLUSIONS: The FLIP panometry contractile response patterns reflect a pathophysiologic transition from normal to abnormal esophageal peristaltic function with shared features with primary peristaltic function/dysfunction on HRM. Thus, these patterns of the contractile response to distension can facilitate the evaluation of esophageal motility using FLIP panometry.
BACKGROUND AND AIMS: This study aimed to systematically evaluate a classification scheme of secondary peristalsis using functional luminal imaging probe (FLIP) panometry through comparison with primary peristalsis on high-resolution manometry (HRM). METHODS: 706 adult patients that completed FLIP and HRM for primary esophageal motility evaluation and 35 asymptomatic volunteers ("controls") were included. Secondary peristalsis, that is, contractile responses (CRs), was classified on FLIP panometry by the presence and pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), absent (ACR), or spastic-reactive (SRCR). Primary peristalsis on HRM was assessed according to the Chicago Classification. RESULTS: All 35 of the controls had antegrade contractions on FLIP panometry with either NCR (89%) or BCR (11%). The average percentages of normal swallows on HRM varied across contractile response patterns from 84% in NCR, 68% in BCR, 39% in IDCR, to 11% in ACR, as did the percentage of failed swallows on HRM: 4% in NCR, 12% in BCR, 36% in IDCR, and 79% in ACR. SRCR on FLIP panometry was observed in 18/57 (32%) patients with type III achalasia, 4/15 (27%) with distal esophageal spasm, and 7/15 (47%) with hypercontractile esophagus on HRM. CONCLUSIONS: The FLIP panometry contractile response patterns reflect a pathophysiologic transition from normal to abnormal esophageal peristaltic function with shared features with primary peristaltic function/dysfunction on HRM. Thus, these patterns of the contractile response to distension can facilitate the evaluation of esophageal motility using FLIP panometry.
Authors: Joseph R Triggs; Dustin A Carlson; Claire Beveridge; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2019-11-25 Impact factor: 11.382
Authors: P J Kahrilas; A J Bredenoord; M Fox; C P Gyawali; S Roman; A J P M Smout; J E Pandolfino Journal: Neurogastroenterol Motil Date: 2014-12-03 Impact factor: 3.598
Authors: Dustin A Carlson; C Prakash Gyawali; Abraham Khan; Rena Yadlapati; Joan Chen; Reena V Chokshi; John O Clarke; Jose M Garza; Anand S Jain; Philip Katz; Vani Konda; Kristle Lynch; Felice H Schnoll-Sussman; Stuart J Spechler; Marcelo F Vela; Jacqueline E Prescott; Alexandra J Baumann; Erica N Donnan; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Am J Gastroenterol Date: 2021-12-01 Impact factor: 10.864
Authors: Dustin A Carlson; Christina Shehata; Nirmala Gonsalves; Ikuo Hirano; Stephanie Peterson; Jacqueline Prescott; Domenico A Farina; Jacob M Schauer; Wenjun Kou; Peter J Kahrilas; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2021-11-09 Impact factor: 13.576
Authors: Dustin A Carlson; Jacqueline E Prescott; Emma Germond; Darren Brenner; Mary Carns; Chase S Correia; Marie-Pier Tetreault; Zsuzsanna H McMahan; Monique Hinchcliff; Wenjun Kou; Peter J Kahrilas; Harris R Perlman; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-10-28 Impact factor: 3.960