Skip to main content
Journal cover image

Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes.

Publication ,  Journal Article
Blais, P; Patel, A; Sayuk, GS; Gyawali, CP
Published in: Neurogastroenterol Motil
December 2017

BACKGROUND: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. METHODS: Within consecutive patients undergoing esophageal high-resolution manometry (HRM), 302 patients (58.2±1.0 year, 57% F) with esophageal outflow obstruction were identified, and compared to 16 asymptomatic controls (27.7±0.7 year, 56% F). Esophageal outflow obstruction was segregated into achalasia subtypes 1, 2, and 3, and esophagogastric junction outflow obstruction (EGJOO with intact peristalsis) using Chicago Classification v3.0. UES and lower esophageal sphincter (LES) metrics were compared between esophageal outflow obstruction and normal controls using univariate and multivariate analysis. Linear regression excluded multicollinearity of pressure metrics that demonstrated significant differences across individual subtype comparisons. KEY RESULTS: LES integrated relaxation pressure (IRP) had utility in differentiating achalasia from controls (P<.0001), but no utility in segregating between subtypes (P=.27). In comparison to controls, patients collectively demonstrated univariate differences in UES mean basal pressure, relaxation time to nadir, recovery time, and residual pressure (UES-RP) (P≤.049). UES-RP was highest in type 2 achalasia (P<.0001 compared to other subtypes and controls). In multivariate analysis, only UES-RP retained significance in comparison between each of the subgroups (P≤.02 for each comparison). Intrabolus pressure was highest in type 3 achalasia; this demonstrated significant differences across some but not all subtype comparisons. CONCLUSIONS AND INFERENCES: Nadir UES-RP can differentiate achalasia subtypes within the esophageal outflow obstruction spectrum, with highest values in type 2 achalasia. This metric likely represents a surrogate marker for esophageal pressurization.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

December 2017

Volume

29

Issue

12

Location

England

Related Subject Headings

  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophageal Sphincter, Upper
  • Esophageal Achalasia
  • Aged
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Blais, P., Patel, A., Sayuk, G. S., & Gyawali, C. P. (2017). Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes. Neurogastroenterol Motil, 29(12). https://doi.org/10.1111/nmo.13136
Blais, P., A. Patel, G. S. Sayuk, and C. P. Gyawali. “Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes.Neurogastroenterol Motil 29, no. 12 (December 2017). https://doi.org/10.1111/nmo.13136.
Blais P, Patel A, Sayuk GS, Gyawali CP. Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes. Neurogastroenterol Motil. 2017 Dec;29(12).
Blais, P., et al. “Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes.Neurogastroenterol Motil, vol. 29, no. 12, Dec. 2017. Pubmed, doi:10.1111/nmo.13136.
Blais P, Patel A, Sayuk GS, Gyawali CP. Upper esophageal sphincter (UES) metrics on high-resolution manometry (HRM) differentiate achalasia subtypes. Neurogastroenterol Motil. 2017 Dec;29(12).
Journal cover image

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

December 2017

Volume

29

Issue

12

Location

England

Related Subject Headings

  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophageal Sphincter, Upper
  • Esophageal Achalasia
  • Aged
  • Adult