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Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry.

Publication ,  Journal Article
Quader, F; Reddy, C; Patel, A; Gyawali, CP
Published in: Am J Physiol Gastrointest Liver Physiol
July 1, 2017

Elevated integrated relaxation pressure (IRP) on esophageal high-resolution manometry (HRM) identifies obstructive processes at the esophagogastric junction (EGJ). Our aim was to determine whether intrabolus pressure (IBP) can identify structural EGJ processes when IRP is normal. In this observational cohort study, adult patients with dysphagia and undergoing HRM were evaluated for endoscopic evidence of structural EGJ processes (strictures, rings, hiatus hernia) in the setting of normal IRP. HRM metrics [IRP, distal contractile integral (DCI), distal latency (DL), IBP, and EGJ contractile integral (EGJ-CI)] were compared among 74 patients with structural EGJ findings (62.8 ± 1.6 yr, 67.6% women), 27 patients with normal EGD (52.9 ± 3.2 yr, 70.3% women), and 21 healthy controls (27.6 ± 0.6 yr, 52.4% women). Findings were validated in 85 consecutive symptomatic patients to address clinical utility. In the primary cohort, mean IBP (18.4 ± 0.9 mmHg) was higher with structural EGJ findings compared with dysphagia with normal EGD (13.5 ± 1.1 mmHg, P = 0.002) and healthy controls (10.9 ± 0.9 mmHg, P < 0.001). However, mean IRP, DCI, DL, and EGJ-CI were similar across groups (P > 0.05 for each comparison). During multiple rapid swallows, IBP remained higher in the structural findings group compared with controls (P = 0.02). Similar analysis of the prospective validation cohort confirmed IBP elevation in structural EGJ processes, but correlation with dysphagia could not be demonstrated. We conclude that elevated IBP predicts the presence of structural EGJ processes even when IRP is normal, but correlation with dysphagia is suboptimal.NEW & NOTEWORTHY Integrated relaxation pressure (IRP) above the upper limit of normal defines esophageal outflow obstruction using high-resolution manometry. In patients with normal IRP, elevated intrabolus pressure (IBP) can be a surrogate marker for a structural restrictive or obstructive process at the esophagogastric junction (EGJ). This has the potential to augment the clinical value of esophageal HRM by raising suspicion for a structural EGJ process when IBP is elevated.

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Published In

Am J Physiol Gastrointest Liver Physiol

DOI

EISSN

1522-1547

Publication Date

July 1, 2017

Volume

313

Issue

1

Start / End Page

G73 / G79

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pressure
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction
  • Deglutition Disorders
 

Citation

APA
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MLA
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Quader, F., Reddy, C., Patel, A., & Gyawali, C. P. (2017). Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry. Am J Physiol Gastrointest Liver Physiol, 313(1), G73–G79. https://doi.org/10.1152/ajpgi.00091.2017
Quader, Farhan, Chanakyaram Reddy, Amit Patel, and C Prakash Gyawali. “Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry.Am J Physiol Gastrointest Liver Physiol 313, no. 1 (July 1, 2017): G73–79. https://doi.org/10.1152/ajpgi.00091.2017.
Quader F, Reddy C, Patel A, Gyawali CP. Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry. Am J Physiol Gastrointest Liver Physiol. 2017 Jul 1;313(1):G73–9.
Quader, Farhan, et al. “Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry.Am J Physiol Gastrointest Liver Physiol, vol. 313, no. 1, July 2017, pp. G73–79. Pubmed, doi:10.1152/ajpgi.00091.2017.
Quader F, Reddy C, Patel A, Gyawali CP. Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry. Am J Physiol Gastrointest Liver Physiol. 2017 Jul 1;313(1):G73–G79.

Published In

Am J Physiol Gastrointest Liver Physiol

DOI

EISSN

1522-1547

Publication Date

July 1, 2017

Volume

313

Issue

1

Start / End Page

G73 / G79

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pressure
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction
  • Deglutition Disorders