Alimentary TractDoes this patient have oesophageal motility abnormality or pathological acid reflux?
Introduction
Since the introduction of conventional oesophageal manometry and ambulatory 24-h pH monitoring, interest in and understanding of oesophageal motility abnormality and pathological acid exposure have considerably increased [1], [2], [3]. Although oesophageal symptoms cannot be, in general, regarded as harbingers of oesophageal motility abnormality or pathological acid exposure, sophisticated diagnostic methods do not diminish the clinical importance of a thorough medical history.
The information about the sensitivity, positive predictive value (PPV) and likelihood ratio (LR) of oesophageal motility abnormality and pathological acid exposure in respect of oesophageal symptoms may play an important role not only for the prediction of oesophageal motility abnormality or pathological acid exposure in patients with such complaints, but also in the process of referring patients for costly and laborious examinations [1], [2], [3], [4]. However, the sensitivity, PPV and LR of oesophageal motility abnormality and pathological acid exposure with regard to oesophageal symptoms are not yet fully understood [2], [3], [4], [5], [6], [7]. Although some previous reports have addressed the subject, most of these studies limited their assessments to patients who had undergone either manometry or pH monitoring alone, or to patients with individual symptoms, including non-cardiac chest pain, dysphagia or some extraoesophageal manifestations [2], [3], [4], [5], [8], [9], [10].
The aim of this study was to determine the predictive accuracy of symptoms centred on the oesophagus in diagnosis of oesophageal motility disorder or pathological acid exposure in 462 Korean patients who had undergone conventional oesophageal manometry and ambulatory 24-h pH monitoring to investigate a clinical suspicion of oesophageal motility abnormality and pathological acid exposure.
Section snippets
Subjects
In the 8-year span from May 1995 to August 2003, the medical records of 550 consecutive patients who had undergone conventional oesophageal manometry and ambulatory 24-h pH monitoring at the gastrointestinal motility laboratory of the Samsung Medical Centre, in Seoul, Korea, were reviewed. Among them, patients who had undergone manometry and pH monitoring to investigate a clinical suspicion of oesophageal motility abnormalities and pathological acid exposure within 1 month were included in this
Results
The baseline characteristics of the patients and distribution of normal and abnormal findings of oesophageal tests with regard to symptoms centred on the oesophagus are shown in Table 2. Non-cardiac chest pain was the most common complaint, and was noted in 184 out of 462 patients (40%). Abnormal results of oesophageal tests were noted in 202 of the total patients (44%). However, the sensitivities, PPVs and LRs of all symptom categories were inconclusive as to which oesophageal symptoms were
Discussion
The diagnostic value of particular oesophageal symptoms among patients with suspected oesophageal motility abnormality or pathological acid exposure is still unknown [2], [3], [4], [5], [6], [7]. The aim of this study was to determine the predictive accuracy of oesophageal symptoms with regard to the diagnosis of oesophageal motility abnormality or pathological acid exposure. When oesophageal motility abnormalities or pathological acid exposure were suspected from the patient history or
References (38)
- et al.
American Gastroenterological Association technical review on the clinical use of esophageal manometry
Gastroenterology
(1994) Dysphagia: evaluation and treatment
Gastroenterol Clin North Am
(2003)- et al.
Noncardiac chest pain: evaluation and treatment
Gastroenterol Clin North Am
(2003) - et al.
Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain
Gastroenterology
(1990) - et al.
A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment
Am J Gastroenterol
(2001) - et al.
Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study
Am J Gastroenterol
(2001) - et al.
Spontaneous noncardiac chest pain. Evaluation by 24-hour ambulatory esophageal motility and pH monitoring
Gastroenterology
(1988) - et al.
Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment
Clin Gastroenterol Hepatol
(2004) - et al.
Oesophageal motility disorders
Lancet
(2002) - et al.
24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain
Gastroenterology
(1986)
New therapeutic modalities for benign oesophageal disease: an overview
Dig Liver Dis
Nutcracker esophagus: GERD or an esophageal motility disorder
Am J Gastroenterol
Esophageal dysmotility and gastroesophageal reflux disease
J Gastrointest Surg
Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients
Ann Intern Med
Assessment of oesophageal motor function in patients with dysphagia or chest pain—the clinical outcomes research initiative experience
Aliment Pharmacol Ther
The prevalence of symptoms suggestive of esophageal disorders
Scand J Gastroenterol
Esophageal dysmotility as an important co-factor in extraesophageal manifestations of gastroesophageal reflux
Laryngoscope
Abnormal oesophageal motility in patients with chronic cough
Thorax
Gastroesophageal reflux, motility disorders, and psychological profiles in the etiology of globus pharyngis
Laryngoscope
Cited by (14)
Incidence of Achalasia in South Australia Based on Esophageal Manometry Findings
2017, Clinical Gastroenterology and HepatologyCitation Excerpt :We considered the frequency of travel elsewhere for motility studies to be negligible because the nearest neighboring manometry laboratory is 700 km away. In recent times there has been an increased recognition of the importance of manometry in investigating benign esophageal disease20 and an improvement in diagnostic pathways for esophageal diseases. In past studies of incidence, diagnoses of achalasia often have been made using clinical history, barium study, and endoscopy.
Is all ineffective esophageal motility the same? A clinical and high-frequency intraluminal US study
2008, Gastrointestinal EndoscopyCitation Excerpt :The esophageal acid exposure values (percentage of the time the pH was <4.0) were calculated by using a commercial software program (EsoPHogram, version 5.70C2; Gastrosoft, Irving, Tex). Pathologic acid exposure was defined as an intraesophageal pH of <4 for more than 4.0% of the recording time.22,23 All investigations were conducted with the subject in the supine position, after an overnight fast, by using a catheter assembly that consisted of a 2.3-mm-diameter US probe equipped with a 20-MHz transducer (model UM-3R; Olympus).
Mixed Esophageal Disease (MED): A New Concept
2023, Digestive Diseases and SciencesClinical utility of esophageal manometry in the patients with dysphagia – Experience from Sudan
2016, International Journal of Health ScienceHigh-resolution esophageal pressure topography for esophageal motility disorders
2016, Tehran University Medical Journal