E0209 - Esophageal High Resolution Manometry Classification and Symptoms in an Safety-Net vs Private Academic Hospital

Ibrahim Abboud, ¹, Joshua Castle, ¹, Chloe Tom, MD², Tapas Tejura, MD¹, Yan Jiang, MD¹, Sonia Sharma, MD³, Jennifer Dodge, MPH¹, Hina Chowdhry, BS¹, Edy Soffer, MD¹, Anisa Shaker, MD^1
1Keck School of Medicine of USC, Los Angeles, CA; ²LAC+USC, Los Angeles, CA; ³Keck School of Medicine, University of Southern California, Los Angeles, CA

Introduction: The association between esophageal symptoms and high-resolution manometry (HRM) findings have not been evaluated in a safety-net hospital where patients frequently present with advanced disease. We aimed to compare esophageal HRM diagnoses and symptoms between this setting vs a tertiary academic center, using patient-reported outcomes (PROs).

Methods: Adults undergoing standardized esophageal HRM manometry at a safety-net (site 1) and the affiliated academic tertiary care (site 2) hospital were prospectively administered EDQ and GERDQ questionnaires in English or validated Spanish versions according to patient preference. HRM findings were reported per Chicago Classification V4. Patient records were reviewed to quantify symptom duration and esophageal diameter in achalasia patients. Multivariable logistic regression was used for the association of EDQ≥7 with HRM site.

Results: 73 and 178 patients were included at sites 1 and 2, respectively; at site 1, 73% of PROs were administered in Spanish, 27% in English; all site 2 surveys were in English. Ages were similar and a higher % of women had esophageal HRM at both sites. Among HRM diagnoses, there were site differences in the % of IEM (6.8% vs 18.5%, p=0.02) and achalasia (13.7% and 6.2%, p-0.05). Type 2 achalasia was the most frequent sub-type at both sites. For those with achalasia, symptom duration and esophageal diameter were similar at both sites.



GERDQ scores were similar between sites 1 and 2 (overall and for each HRM diagnosis). Median EDQ scores were higher at site 1 vs 2 (25 vs 8, p< 0.001). A higher % of normal HRMs had EDQ scores ≥ 7 at site 1 vs 2 (85.7% vs 54.6%, p< 0.001). There was no difference in % of EDQ ≥ 7 among diagnoses of IEM, EGJOO, hypercontractile, achalasia, and absent contractility between sites. Multivariable analysis shows that the odds of EDQ ≥ 7 remains higher at site 1 vs 2 after adjusting for age, gender, and diagnosis (OR 4.25, 95% CI 2.00-9.05).

Discussion: IEM was more frequently a diagnosis at the private hospital vs achalasia type 2 at the safety net hospital, although symptom duration and esophageal diameter were similar, suggesting similar disease severity. Despite this and an otherwise similar HRM diagnosis profile, dysphagia symptom scores remain more severe in patients at a safety-net hospital vs those at an affiliated private academic, including those normal HRM. This interesting finding without a clear etiology merits further investigation.




Disclosures:


Ibrahim Abboud, ¹, Joshua Castle, ¹, Chloe Tom, MD², Tapas Tejura, MD¹, Yan Jiang, MD¹, Sonia Sharma, MD³, Jennifer Dodge, MPH¹, Hina Chowdhry, BS¹, Edy Soffer, MD¹, Anisa Shaker, MD¹. E0209 - Esophageal High Resolution Manometry Classification and Symptoms in an Safety-Net vs Private Academic Hospital, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.