Abstract
ABSTRACT
Background/Aims
High resolution oesophageal manometry (HRM) is a result of recent development of catheters with an increased number of pressure sensors aimed to improve the quality of oesophageal pressure measurement and diagnosis. We wanted to conduct a descriptive analysis of the patient population referred to HRM and ambulatory 24 h pH-monitoring at Oslo university hospital, Ullevål, regarding age, gender, presenting symptoms and the main findings of oesophageal manometry- and pH-monitoring. In addition, these findings were used to study whether there is a relationship between ineffective oesophageal motility (IEM) and gastrooesophageal reflux.
Patients and methods
We conducted a retrospective database review of 149 patients examined with HRM, of which 105 also underwent 24 h pH-monitoring in the absence of antisecretory therapy. Patients only examined with pH-monitoring were not included. Established definitions of oesophageal motility were applied.
Results
The most common symptoms causing referral were classic reflux symptoms including heartburn and acid regurgitation (43%), which together with non-cardiac chest pain and dysphagia accounted for more than 90% of all referrals. Abnormal motility was found in 70% of the patients and IEM was the most common finding (49%). Pathological oesophageal acid exposure (pH<4 more than 4.2% of the total monitoring time) was found in 54% of the patients. Patients with IEM showed significant increase in time with pH<4 (6.7%) in the distal oesophagus in the supine position compared with those with normal motility (2%, p=0.018). For acid exposure in the upright position or total time of pH<4 no difference was found. Furthermore, there was no relation between IEM and symptoms or previous endoscopic findings.
Conclusion
IEM was the most frequent motility abnormality and was found in almost half of the patients studied with manometry. However, there was no relation between the presence of IEM and symptoms, although patients with IEM have a lower pH in the oesophagus in the supine position. Hence, the present study questions the clinical usefulness of the IEM-diagnosis when performing HRM and suggests that the diagnostic criteria should be revised.