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Am J Physiol Gastrointest Liver Physiol 293: G878-G885, 2007. First published August 9, 2007; doi:10.1152/ajpgi.00252.2007
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NEUROREGULATION AND MOTILITY

Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls

Sudip K. Ghosh, John E. Pandolfino, John Rice, John O. Clarke, Monika Kwiatek, and Peter J. Kahrilas

Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Submitted 6 June 2007 ; accepted in final form 8 August 2007

Assessing deglutitive esophagogastric junction (EGJ) relaxation is an essential focus of clinical manometry. Our aim was to apply automated algorithmic analyses to high-resolution manometry (HRM) studies to ascertain the optimal method for discriminating normal from abnormal deglutitive EGJ relaxation. All 473 subjects (73 controls) were studied with a 36-channel solid-state HRM assembly during water swallows. Patients were classified as: 1) achalasia, 2) postfundoplication, 3) nonachalasia with normal deglutitive EGJ relaxation, or 4) functional obstruction (preserved peristalsis with incomplete EGJ relaxation). Automated computer programs assessed the adequacy of EGJ relaxation by using progressively complex analysis routines to compensate for esophageal shortening, crural diaphragm contraction, and catheter movement, all potential confounders. The single-sensor method of assessing EGJ relaxation had a sensitivity of only 52% for detecting achalasia. Of the automated HRM analysis paradigms tested, the 4-s integrated relaxation pressure using a cutoff of 15 mmHg performed optimally with 98% sensitivity and 96% specificity in the detection of achalasia. We also identified a heterogeneous group of 26 patients with functional EGJ obstruction attributed to variant achalasia and other diverse pathology. Although further clinical experience will ultimately judge, it is our expectation that applying rigorous methodology such as described herein to the analysis of HRM studies will improve the consistency in the interpretation of clinical manometry and prove useful in guiding clinical management.

esophageal manometry; lower esophageal sphincter; esophagogastric junction; achalasia


Address for reprint requests and other correspondence: S. K. Ghosh, Northwestern Univ., Feinberg School of Medicine, Division of Gastroenterology, Dept. of Medicine, 676 N. St., Clair St., Suite 1400, Chicago, IL 60611 (e-mail: s-ghosh{at}northwestern.edu)






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