Poster Session II A334 PATTERNS AND DIAGNOSTIC YIELD OF ESOPHAGEAL MOTILITY DISORDERS: A RETROSPECTIVE HIGH-RESOLUTION MOTILITY STUDY

TL;DR

This study analyzed esophageal motility disorders in Southwestern Ontario, finding that achalasia and ineffective motility were common, especially in patients with dysphagia or GERD symptoms.

Contribution

The study provides a detailed prevalence analysis of esophageal motility disorders using high-resolution manometry data from a regional population.

Findings

Achalasia was most commonly diagnosed in patients referred for dysphagia.

Ineffective esophageal motility was the most prevalent diagnosis among GERD referrals.

Most HREM studies were normal, with 43% showing abnormal motility findings.

Abstract

Esophageal motility disorders are underreported in Canada and remain a clinical challenge that impacts quality of life. High-resolution esophageal manometry (HREM) is the gold standard for their diagnosis.

Primary Aim: To determine the prevalence of esophageal motility disorders in a population of patients from Southwestern Ontario referred for (HREM).

Secondary Aim: To evaluate various HREM parameters across normal and abnormal studies.

A retrospective analysis was conducted on patients who underwent HREM at St. Joseph Hospital, in London, Ontario, from Jan 1st, 2014, until Sep 15, 2024. Data was extracted from a motility database of patients who had undergone HREM. The data included patient characteristics, medications, symptoms, and comorbidities, along with indications for HREM, HREM parameters, measurements, and the final diagnosis.

A total of 1352 patients were included in the final analysis, with the majority being Female (822/1352, 60.8%). Mean age was 54.12 (18-96) years, with an average weight of 80.4 kg (25.4 - 185 kg) and a mean height of 168.03 cm (81–201 cm).

The most common indication for HREM was dysphagia (587/1352;43.4%), followed by typical GERD symptoms, both heartburn and regurgitation (514/1352;38%).

HREM revealed abnormal findings in 582/1352 (43%) of patients, whereas 770/1352 (57%) had normal study results. Ineffective esophageal motility (IEM) was the most prevalent diagnosis (98/1352; 7.2%), followed by achalasia (95/1352; 7.03%) and EGJ outflow obstruction (31/1352; 2.3%).

The prevalence of dysphagia was significantly higher among patients with achalasia (80/95; 84.2%) than among those with normal manometry (282/770; 36.6%; p < 0.001). Referral for GERD symptoms occurred in 53.1% (52/98) of IEM patients versus 42.3% (326/770) of those with normal manometry (p = 0.056), indicating no significant difference.

PPI use vs no PPI use was associated with lower LES residual pressure (6.81 ± 8.11 mmHg vs 9.16 ± 10.41 mmHg) and LES basal pressure (24.33 ± 15.85 mmHg vs 28.75 ± 16.98 mmHg), both p < 0.001. Opioid use vs non-opioid use showed higher LES basal pressure (30.57 ± 18.67 vs 25.32 ± 16.11, p = 0.007), but no significant difference in LES residual pressure.

Most HREM studies were normal, with achalasia and IEM being the most common abnormalities—achalasia mostly in dysphagia referrals and IEM in GERD referrals (not statistically significant). These findings highlight indication-specific likelihoods and HREM’s role in triage. Larger, multicenter studies with adjustments and linked pH/EGD data are needed to confirm their robustness and clinical relevance.

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