University of South Florida Tampa, FL, United States
Samuel O. Slone, MD1, Ambuj Kumar, MD2, Joel Richter, MD1 1University of South Florida, Tampa, FL; 2University of South Florida Morsani College of Medicine, Tampa, FL
Introduction: Achalasia is a rare motility disorder of the esophagus and its diagnosis remains challenging. Most commonly used tests for diagnose are EGD, barium esophagram (BE) and high-resolution manometry (HRM). However, the diagnostic accuracy of these tests and there community usage have not been assessed. Our goal was to assess 1) the real-world diagnostic accuracies of commonly used tests used for diagnosing achalasia, 2) frequency and order of tests for diagnosing achalasia
Methods: Consecutive patients with suspected but previously undiagnosed achalasia evaluated at our institution between 2016-20 were eligible. Demographics and clinical variables including history of diagnostic testing in the community were obtained from EMR.. Diagnostic accuracy measures and descriptive statistics were used to address the goals of the study.
Results: 103 patients (55 men, average age 66 years) met the inclusion criteria. Average symptom duration prior to diagnosis was 57 months. At initial presentation, patients endorsed dysphagia to solids and liquids (56.3%), dysphagia to solids only (35.9%), dysphagia to liquids only (1%), and no dysphagia (6.8%). 81 patients had achalasia (16% type 1, 73% type 2, 11% type 3) and 22 other diagnoses (15 EGJOO, 1 jackhammer, 1 ineffective esophageal motility, 3 GERD, 1 peptic stricture, 1 and functional dysphagia). The diagnostic accuracy of HRM was 65% and used as a first diagnostic test in only 1% of cases [Figures 1,2]. The diagnostic accuracy of BE was 40% and used as a first diagnostic test in 16% of cases. The diagnostic accuracy of EGD was 37% and used in 74% of the cases as the first diagnostic test. 86% of patients (89/103) underwent second diagnostic testing. EGD was the most used second line diagnostic test (42%) followed by BE (29%) and HRM (12%). 51% of patients (52/103) underwent third line testing. EGD was again most common diagnostic test (20%), followed by HRM (18%) and BE (10%).
Discussion: Our study shows that HRM is associated with highest accuracy for diagnosing achalasia. However, HRM is rarely used as first or second line testing and the most likely factor associated with diagnostic delay. Even when HRM is used, the diagnosis of achalasia was not conclusive (65% accuracy) in the community setting. EGD is widely used in the community setting despite poor diagnostic yield. HRM should be recommended as second line test if EGD does not yield diagnosis of dysphagia.
Figure: Accuracy vs First ordered tests in achalasia
Samuel Slone indicated no relevant financial relationships.
Ambuj Kumar indicated no relevant financial relationships.
Joel Richter indicated no relevant financial relationships.
Samuel O. Slone, MD1, Ambuj Kumar, MD2, Joel Richter, MD1. P1371 - The Diagnostic Accuracy of Commonly Used Tests for Achalasia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.