Upper esophageal sphincter (UES) metrics on high‐resolution manometry (HRM) differentiate achalasia subtypes. Issue 12 (14th July 2017)

• Record Type: Journal Article
• Authors: Blais, P.; Patel, A.; Sayuk, G. S.; Gyawali, C. P.
• Is Part Of: Neurogastroenterology & motility. Volume 29:Issue 12(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-07-14
• Subjects: achalasia -- esophageal pressurization -- esophagogastric junction outflow obstruction (EGJOO) -- high‐resolution manometry (HRM) -- upper esophageal sphincter; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13136
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. Methods: Within consecutive patients undergoing esophageal high‐resolution manometry (HRM), 302 patients (58.2±1.0 year, 57% F) with esophageal outflow obstruction were identified, and compared to 16 asymptomatic controls (27.7±0.7 year, 56% F). Esophageal outflow obstruction was segregated into achalasia subtypes 1, 2, and 3, and esophagogastric junction outflow obstruction (EGJOO with intact peristalsis) using Chicago Classification v3.0. UES and lower esophageal sphincter (LES) metrics were compared between esophageal outflow obstruction and normal controls using univariate and multivariate analysis. Linear regression excluded multicollinearity of pressure metrics that demonstrated significant differences across individual subtype comparisons. Key Results: LES integrated relaxation pressure (IRP) had utility in differentiating achalasia from controls ( P <.0001), but no utility in segregating between subtypes ( P =.27). In comparison to controls, patients collectively demonstrated univariate differences in UES mean basal pressure, relaxation time to nadir, recovery time, and residual pressure (UES‐RP) ( P ≤.049). UES‐RP was highest in type 2 achalasia ( P <.0001 compared to other subtypes and controls). In multivariate analysis, only UES‐RP retained significance in comparison between each of the subgroups ( P ≤.02 for each comparison). Intrabolus pressure was highest in type 3 achalasia; this demonstrated significant differences across some but not all subtype comparisons. Conclusions and Inferences: Nadir UES‐RP can differentiate achalasia subtypes within the esophageal outflow obstruction spectrum, with highest values in type 2 achalasia. This metric likely represents a surrogate marker for esophageal pressurization. Abstract : Elevated integrated residual pressure (IRP) at the lower esophageal sphincter (LES) on esophageal high‐resolution manometry (HRM) defines esophageal outflow obstruction, but UES metrics can also be abnormal in these disorders. We characterized UES metrics in esophageal outflow obstruction, and report that nadir UES residual pressure (UES‐RP) is consistently higher compared to normal controls. Values are highest in type 2 achalasia, potentially a consequence of esophageal pressurization. Characterizing UES abnormalities, particularly nadir UES‐RP, can complement esophageal body and LES metrics in segregating achalasia subtypes.