反流transit abnormalities

W1828
Evaluation of transit in the transition zone on multichannel intraluminal impedance (MII) allows detection of transit abnormalities in more patients with abnormal motility
Amine Hila, Amit Agrawal, Wojciech Blonski, Inder Mainie, Janice Freeman, Donald O Castell Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA
Abstract Body: BACKGROUND: Combined MII and esophageal manometry (MII-EM) allows both functional and manometric evaluation of esophagus. MII-EM catheter has 4 impedance segments
(5,10,15,20cm above LES) and 5 pressure sites (at LES and 5,10,15,20cm above LES). Manometric diagnoses are based on data provided by sites in distal 10cm of esophagus; i.e. smooth muscle. Site at 15cm above the LES is not included as it may contain smooth and striated muscle (transition area). Evaluation of swallows with MII is assessed for complete or incomplete transit, defined by bolus entry at 20cm and bolus exit in 15, 10 and 5cm segments. Does inclusion of the 15cm segment, which is in the transition zone, overly detects abnormalities in patients with normal manometry? AIM: To assess the effect of using impedance data from the transition zone on accuracy of MII-EM interpretation. METHODS: 200 consecutive MII-EM studies (65% females; mean age=54yrs). All patients given 10 saline and 10 viscous swallows while recumbent. All tracings initially read defining complete transit for each swallow based on bolus entry at 20cm and bolus exit at 15, 10 and 5cm. Then, all tracings read a 2nd time with complete transit defined by bolus entry at 20cm and bolus exit at 10 and 5 cm, thus excluding transition zone. Manometric and transit diagnoses from these 2 different reading methods were compared. RESULTS: Excluding transition zone from impedance analysis changed transit diagnosis from incomplete to complete transit in 33 patients (17%): 16 changed in liquid transit, 16 in viscous transit and 1 in both. 1st table summarizes prevalence of manometric diagnoses in all patients (group A), and in the 33 where transit diagnosis changed (group B). In patients where transit diagnosis changes from normal to abnormal with addition of transition zone, a higher percentage of patients have abnormal manometric finding. In all studies, there were 3962 swallows (group C), of which 226 swallows (group D) changed diagnosis. 2nd table summarizes prevalence of manometric diagnoses by swallows. In swallows where transit diagnosis changes from normal to abnormal with addition of transition zone, a higher percentage have abnormal manometry. CONCLUSION: Using findings from the transition zone in the transit diagnosis detects transit abnormalities in more patients with abnormal manometry than in patients with normal manometry.
Normal IEM Spasm Achalasia Nutcracker Group A58%18%15%7%2%
Group B40%36%24%00
Swallows Normal Ineffective Simultaneous
Group C64%28%8%
Group D43%41%16%
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