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Predictors of Abnormal Functional Luminal Impedance Planimetry Findings in Non-mechanical Esophagogastric Junction Outflow Obstruction

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Abstract

Background

Esophagogastric junction outflow obstruction (EGJOO) is a common but nonspecific motility pattern identified by esophageal high-resolution manometry (HRM). Functional luminal impedance planimetry (FLIP) provides information regarding lower esophageal sphincter (LES) mechanics, which can identify achalasia spectrum disorders and is useful in evaluating EGJOO. However, the relationship between HRM and FLIP parameters in EGJOO is not clearly defined.

Aims

To identify predictors of abnormal FLIP findings in patients with non-mechanical EGJOO.

Methods

This is a retrospective cohort study of patients with non-mechanical EGJOO who underwent FLIP between 10/1/16 and 7/1/19. Demographic data including age and gender, examination indication, concomitant medications, HRM parameters, symptom burden, and FLIP metrics of diameter and distensibility index (DI) were collected. DI was categorized as not low (DI > 2.8), borderline low (DI 1.1–2.8), and definitely low (DI ≤ 1). Kruskal–Wallis and Fisher’s exact tests were used to assess the relationship between HRM and FLIP parameters and to identify predictors of abnormal FLIP.

Results

Among the 44 patients studied, most were female (n = 33, 75%) and the median age was 63. The median IRP was 18.2, and 10 (23%) patients used chronic narcotics. Lower total heartburn and regurgitation scores, and LES diameter by FLIP are associated with definitely low DI.

Conclusions

In patients with non-mechanical EGJOO, reflux burden scores and FLIP diameters can aid in predicting DI. These results may provide useful adjunctive data to help in differentiating which patients have meaningful outflow obstruction.

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Acknowledgments

The authors thank Richard K. Wood (RKW) for his esophageal function test interpretation. All authors approved the final version of the article.

Funding

This work was supported in part by a Duke Faculty Resident Research Grant (ATR) and the Duke CTSA Grant (UL1TR002553) (AP, DN).

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Authors and Affiliations

  1. Department of Medicine, Duke University, 2301 Erwin Road, Durham, NC, 27710, USA

    Alexander T. Reddy

  2. Division of Gastroenterology, Duke University School of Medicine, 200 Morris Street, Suite 6524, Durham, NC, 27705, USA

    Rahul A. Shimpi & David A. Leiman

  3. Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 802, Durham, NC, 27705, USA

    Alice Parish & Donna Niedzwiecki

  4. Duke Clinical Research Institute, 2424 Erwin Road, Suite 802, Durham, NC, 27705, USA

    David A. Leiman

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  1. Alexander T. Reddy
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  2. Rahul A. Shimpi
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Contributions

ATR and DAL contributed to project conception/design, data collection, data analysis/interpretation, drafting of the manuscript, critical revision, and approval of the final draft. RAS contributed to project conception/design, data collection, drafting of the manuscript, critical revision, and approval of the final draft. AP and DN helped in data analysis/interpretation, drafting of the article, critical revision, and approval of the final draft.

Corresponding author

Correspondence to David A. Leiman.

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Conflicts of interest

DAL receives educational fees from Medtronic. There are no other potential conflicts of interest for any of the authors pertaining to this study.

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Reddy, A.T., Shimpi, R.A., Parish, A. et al. Predictors of Abnormal Functional Luminal Impedance Planimetry Findings in Non-mechanical Esophagogastric Junction Outflow Obstruction. Dig Dis Sci 66, 3968–3975 (2021). https://doi.org/10.1007/s10620-020-06726-0

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  • DOI: https://doi.org/10.1007/s10620-020-06726-0

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