P0302 - Patients With Ineffective Esophageal Motility (IEM) on Chicago Classification v4.0 Have Weaker Swallows and Worse Bolus Clearance Than Patients Meeting Only v3.0 Criteria

Christy Chon, MD¹, Maan El Halabi, MD¹, Michael S. Smith, MD, MBA^2
1Mount Sinai St. Luke's and Mount Sinai Roosevelt, New York, NY; ²Mount Sinai West & Mount Sinai Morningside Hospitals, New York, NY

Introduction: Ineffective esophageal motility (IEM) is defined as the presence of frequent low-amplitude or failed peristaltic contractions on high resolution esophageal manometry (HREM). IEM is a common manometric finding with evolving clinical significance as well as diagnostic criteria. The aim of this study was to identify differences in demographic or manometric parameters between patients with IEM as defined by Chicago Classification version 4.0 (CC4, 70%+ ineffective swallows) compared to those with IEM only on version 3.0 (CC3, 50-69.9% ineffective swallows).

Methods: HREM reports from 6/2013-4/2021 were reviewed in this retrospective, high volume single-center study. All IEM patients based on CC3 with available demographic data were included. Demographic data as well as key manometric parameters including mean lower esophageal sphincter (LES) pressure, median integrated relaxation pressure (IRP), distal contractile integral (DCI), percent ineffective bolus clearance, distal latency (DL), and presence of hiatal hernia were collected. Patients were then divided into two groups: those with 50-69.9% ineffective swallows (CC3 only IEM) and those with 70-100% ineffective swallows (CC4 IEM).

Results: A total of 359 patients met inclusion criteria, among which 116 had CC3 only IEM and 243 had CC4 IEM (Table 1). T-test and chi-square analyses were applied and showed the CC4 IEM cohort had significantly lower mean and maximum DCI (p < 0.001), higher incidence of incomplete bolus clearance (p < 0.001), and lower incidence of reported regurgitation (p=0.04) than the CC3 only IEM group. All other demographic and manometric parameters were not statistically different.

Discussion: CC4 updated diagnostic criteria for IEM due to concerns CC3 identified too broad a spectrum of patients for whom there is no direct therapeutic intervention. Retrospective application of the more stringent criteria to a high-volume center’s HREM cohort supports this change, as both peristaltic strength and ability to clear a swallowed bolus were diminished in patients meeting CC4 criteria. A lower incidence of regurgitation is not surprising, as this symptom should be more tied to LES pressure than peristalsis. Of note, there was no statistical difference in dysphagia between the two groups, suggesting dysphagia is not a predictive marker for IEM. Prospective validation of this important criteria change will be essential to informing management decisions once an IEM diagnosis is made.



Disclosures:


Christy Chon, MD¹, Maan El Halabi, MD¹, Michael S. Smith, MD, MBA². P0302 - Patients With Ineffective Esophageal Motility (IEM) on Chicago Classification v4.0 Have Weaker Swallows and Worse Bolus Clearance Than Patients Meeting Only v3.0 Criteria, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.