జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Role of High Resolution Manometry in the Evaluation of Esophageal Symptoms

Arjun Prakash and Anoop K Koshy

Background and Aims Esophageal High Resolution Manometry (HRM) is widely employed for the diagnosis and evaluation of esophageal motor disorders. There is often a dichotomy between HRM findings and various clinicalcorrelates. We attempted to retrospectively evaluate the clinical profiles of patients with their clinical correlates to establish the role of HRM in evaluation of esophageal symptoms. Results Total of 235 patients were studied.Predominant symptoms were Dysphagia (70.6%), Non-cardiac Chest pain (8.5%) and reflux in 9%. Normal HRM was seen in 31.5%, minor motility disorders in 22.5%. Achalasia (61.1%) and Esophago-gastric (EGJ) outflow obstruction (11.1%) was considered as part of the Major disorders. Dysphagia was the most common symptom of which majority of patients had major motility disorders (93 patients (56%)). Normal HRM was seen in 41/166 patients (24.6%) with dysphagia and 68% in NCCP. Only 11% presenting with NCCP had major motility disorder. Half the patients with GERD had a normal HRM study (10/20 patients). On follow up, 78/93 patients (83.8%) were asymptomatic, of which, >50%had normal HRM. Among those with minor motility disorders (n=39), 33(84.6%) were asymptomatic at follow up. Conclusion The significance of HRM in assessment of symptoms other than dysphagia, with diagnosis within the Minor Motility disorders group and associated with benign outcomes, may be questioned. The diagnosis group of Minor Motility disorders, in itself, may be questioned in future Chicago classifications.