D0196 - Severity of Dysphagia Predicts Patients With Obstructive Lower Esophageal Sphincter Physiology

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Anna Goebel, BS, BA

Emory School of Medicine
Atlanta, GA

Anna Goebel, BS, BA¹, Debra Duncan, ², Marie Godiers, BS³, Meredith Kline, MD⁴, Anand Jain, MD³
¹Emory School of Medicine, Atlanta, GA; ²Emory University School of Medicine, Atlanta, GA; ³Emory University, Atlanta, GA; ⁴University of Chicago, Chicago, IL

Introduction: Restrictive function of the lower esophageal sphincter (LES) is the hallmark of achalasia and esophagogastric junction outflow obstruction (EGJOO), which are the most functionally relevant disorders of esophageal motility. We aimed to determine whether the pattern and / or severity of dysphagia can identify patients with obstructive physiology of the lower esophageal sphincter.

Methods: Data from undergoing high-resolution manometry (HRM) according to Chicago Classification (CC) version 4.0 at a tertiary care center were retrospectively analyzed per IRB approved protocol (#109825). The Brief Esophageal Dysphagia Questionnaire (BEDQ) score items were used to construct 3 unbiased latent classes. CC 4.0 diagnosis, functional metrics on HRM, and quantitative metrics were compared.

Results: Data from 147 patients (age range 21 – 92, 66.7 % female) was included (Table 1). Latent class (LC) analysis based on question items 1-8 from the BEDQ showed 3 classes which were predominantly discriminated based on overall BEDQ score (Figure 1). Overall, 43.5% had normal HRM diagnosis based on CC 4.0, and 40.1% had a diagnosis of EGJOO or achalasia. Chi-square analysis showed no differences in the proportions of patients with normal motility. However, the proportion of patients with EGJOO was higher in LC 2. Also, supine integrated relaxation pressure (IRP) was higher in LC 2 and 3 groups. LC 2 had a trend towards a higher distal contractile integral (DCI) which may be the reason for the different symptom profile.

Discussion: A higher severity of dysphagia correlates with a greater degree of obstructive physiology of the LES. Notably, a high percent of patients with more severe dysphagia have normal manometry, which likely underscores the importance of esophageal hypervigilance and visceral anxiety.

Figure: Title: Figure 1
x-axis: Brief esophageal dysphagia questionnaire (BEDQ) Question
y-axis: Average Item Score


	LC 1 (n=51)	LC 2 (n=56)	LC 3 (n=40)	P value
Age [mean (SD)]	[60.9 (16.2)]	[59.1(15.71)]	[52(17.26)]	0.029
% female [number (%)]	[33(64.7%)]	[39(69.7%)]	[26(65.0%)]	0.835
BEDQ score [mean (SD)]	[9.8 (4.9)]	[17.4 (7.3)]	[30.4 (7.4)]	0.000
CC diagnosis [number (%)]
Normal	[22(43.1%)]	[24 (42.9%)]	[18 (45.0%)]	0.975
EGJOO	[9(17.6%)]	[21 (37.50%)]	[5 (12.5%)]	0.008
Ineffective esophageal motility	[6(11.8%)]	[1 (1.8%)]	[4 (10.0%)]	0.132
Type 1 Achalasia	[4(7.8%)]	[2 (3.6%)]	[3 (7.5%)]	0.626
Type 2 Achalasia	[4(7.8%)]	[1 (1.8%)]	[5 (12.5%)]	0.129
Type 3 Achalasia	[1(2.0%)]	[2 (3.6%)]	[2 (5.0%)]	0.782
Combined EGJOO / Achalasia Type 1,2,3	[18 (35.3%)]	[26 (46.4%)]	[15 (37.5%)]	0.465
Absent contractility	[2 (3.9%)]	[3 (5.4%)]	[1 (2.5%)]	0.782
Distal Esophageal Spasm	[1(2.0%)]	[2 (3.6%)]	[2 (5.0%)]	0.733
Hypercontractile esophagus	[2 (3.9%)]	[0 (0.0%)]	[0 (0.0%)]	0.156
LES metrics [mean (SD)]	`
BLESP	[34.0 (39.1)]	[37.2(22.3)]	[35.8(16.1)]	0.838
Supine IRP	[13.5 (7.3)]	[18.4 (10.2)]	[20.2(12.1)]	0.004
Upright IRP	[11.6 (7.3]	[13.5(9.0)]	[14.5(12.8)]	0.346
DCI	[1458.7(2158.8)]	[2138 (3138)]	[1166 (1254)]	0.124
DL	[7.3(2.2)]	[6.7 (1.9)]	[6.8(1.3)]	0.210
Functional markers of impaired bolus transit
% with PEP or CP ≥20% [number (%)]	[(11 (21.6%)]	[21 (37.5%)]	[11 (27.5%)]	0.186
% with IBT ≥20%	[23(45.1%)]	[24(42.9%)]	[18(45.0%)]	0.967

Table: Table 1: Clinical Data Based on Latent Class Groups
Abbreviations: BEDQ – Brief esophageal dysphagia questionnaire, BLESP – Baseline lower esophageal sphincter pressure, CP-Compartmentalized pressurization, DCL-Distal contractile integral, DL- distal latency, EGJOO- Esophagogastric junction outflow obstruction, IBT- Incomplete bolus transit, IRP- Integrated relaxation pressure, LC-Latent class, PEP- Pan-esophageal pressurization

Disclosures:

Anna Goebel indicated no relevant financial relationships.

Debra Duncan indicated no relevant financial relationships.

Marie Godiers indicated no relevant financial relationships.

Meredith Kline indicated no relevant financial relationships.

Anand Jain indicated no relevant financial relationships.

Anna Goebel, BS, BA¹, Debra Duncan, ², Marie Godiers, BS³, Meredith Kline, MD⁴, Anand Jain, MD³. D0196 - Severity of Dysphagia Predicts Patients With Obstructive Lower Esophageal Sphincter Physiology, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.