D0213 - Endoscopic Findings Among Patients With Diagnoses of Ineffective Esophageal Motility (IEM) Per the Chicago Classification Versions 3.0 and 4.0

Kurren Mehta, MD¹, Anthony Horton, MD¹, Ami Patel, MD¹, Monika Fields, RN², Amit Patel, MD, FACG^3
1Duke University School of Medicine, Durham, NC; ²Durham VA Medical Center, Durham, NC; ³Duke University School of Medicine/Durham VA Medical Center, Durham, NC

Introduction: Our understanding of esophageal hypomotility, particularly ineffective esophageal motility (IEM) on high-resolution manometry (HRM), continues to evolve, as evidenced by the Stanford IEM Symposium and the changes in HRM diagnostic criteria for IEM presented in the fourth iteration of the Chicago Classification (CC v4.0). Here, we evaluated endoscopic findings among a cohort of patients with IEM based on CC v3.0 and CC v4.0 diagnostic criteria.

Methods: 450 consecutive patients undergoing HRM were reviewed, and those meeting diagnoses of IEM per CC v3.0 thresholds constituted the study cohort. From HRM studies, the numbers of failed, weak, and fragmented swallows were collected, as well as mean distal contractile integral (DCI). Data from the upper endoscopy performed nearest to the HRM study were collected, specifically hiatus hernia, reflux esophagitis, Barrett’s esophagus, and distal esophageal stenosis. HRM study data were re-interpreted, and those patients meeting CC v4.0 criteria for IEM (“consistent IEM”) were compared to those not meeting CC v4.0 thresholds (“inconsistent IEM”).



Results: 36/450 (8%) patients had diagnoses of IEM per CC v3.0 (58.4±2.8 years, 17% F, 58% Caucasian, BMI 29.6±0.9). 86% were on PPI at evaluation, and 56% had reported some dysphagia on symptom questionnaires. Mean DCI was 359.5±30.1, with 3.0±0.4 failed, 5.0±0.4 weak, and 0.6±0.2 fragmented swallows. Endoscopic findings among the total cohort included hiatus hernia (44%), reflux esophagitis (25%), Barrett’s esophagus (19%), and distal stenosis (8%). 75% of the cohort retained an IEM diagnosis when re-evaluated with CC v4.0 thresholds. When compared to those patients who did not retain an IEM diagnosis, demographic data, clinical characteristics, and endoscopic findings were statistically similar, although no patients with inconsistent IEM had stenosis noted at endoscopy.

Discussion: Hiatus hernia and other endoscopic findings of reflux (particularly reflux esophagitis and Barrett’s esophagus) were common among patients with manometric diagnoses of IEM, despite high rates of PPI use. The proportions with these endoscopic findings did not appear to differ significantly based on whether an IEM diagnosis was consistent with CC v4.0 diagnostic criteria, though all patients with esophageal stenosis at endoscopy had consistent IEM. These findings should encourage further investigations into the potential progression of reflux and its complications among patients with varying degrees of esophageal hypomotility.




Disclosures:


Kurren Mehta, MD¹, Anthony Horton, MD¹, Ami Patel, MD¹, Monika Fields, RN², Amit Patel, MD, FACG³. D0213 - Endoscopic Findings Among Patients With Diagnoses of Ineffective Esophageal Motility (IEM) Per the Chicago Classification Versions 3.0 and 4.0, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.