Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients’ Quality of Life—A Prospective Cohort Study

Background: Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE). Methods: This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, p ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162). Results: Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia. Conclusion: The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients’ quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis.

Download Full-text

PS01.024: ENDOSTIMTM THERAPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.024 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 57-57

Author(s):

Florian Matthias Corvinus ◽

Edin Hadzijusufovic ◽

Benjamin Babic ◽

Hauke Lang ◽

Peter Grimminger

Keyword(s):

Quality Of Life ◽

Esophageal Motility ◽

Conflicts Of Interest ◽

Ph Monitoring ◽

Esophageal Motility Disorders ◽

Barium Swallow ◽

Motility Disorders ◽

Validated Questionnaire ◽

Retrosternal Pain

Abstract Background Electric stimulation of the lower esophageal sphincter is a new surgical option for patients with gastroesophageal reflux disease (GERD) and a diaphragmatic hernia less than 3 cm. In comparison to standard anti-reflux procedures like Nissen or Toupet fundoplication the procedure`s advantage is that there had been no report on postoperative dysphagia. Esophageal motility disorders can increase the risk of dysphagia after fundoplication. Therefor EndostimÔ might be an alternative for these patients. Methods Between December 2015 and November 2017 twelve patients with GERD received Endostim™ therapy. All patients underwent endoscopy, high resolution impedance manometry (HRIM), 24 hour impedance pH-monitoring and a barium swallow. Quality of life was assessed by GERD-HRLQ a validated questionnaire. Results Seven patients with an esophageal motility disorder received an Endostim™ due to symptomatic GERD. Three patients had an esophageal hypomotility, 2 patients had a CREST syndrome and 2 patients showed a functional outflow obstruction in HRIM. There were no postsurgical complications. No dysphagia, regurgitation or retrosternal pain was reported. After a follow up of 6 months all patients are satisfied with the procedure and report an increase of their quality of life. Conclusion These results demonstrate the feasibility of an Endostim™ therapy in patients with esophageal motility disorders for the first time. Disclosure All authors have declared no conflicts of interest.

Download Full-text

How to Cope with Big Data in Functional Analysis of the Esophagus

Visceral Medicine ◽

10.1159/000511931 ◽

2020 ◽

Vol 36 (6) ◽

pp. 439-442

Author(s):

Alissa Jell ◽

Christina Kuttler ◽

Daniel Ostler ◽

Norbert Hüser

Keyword(s):

Esophageal Motility ◽

Learning Algorithm ◽

Supervised Machine Learning ◽

Esophageal Motility Disorders ◽

Motility Disorders ◽

High Resolution Manometry ◽

Evaluation Time ◽

Core Evaluation

Introduction: Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. Methods: On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. Results: For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. Conclusion: This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

Download Full-text

Dysphagia

10.2310/surg.2002 ◽

2019 ◽

Author(s):

R. Sudhir Sundaresan ◽

Anna L. McGuire

Keyword(s):

Eosinophilic Esophagitis ◽

Diagnostic Tests ◽

Esophageal Motility ◽

Esophageal Motility Disorders ◽

Caustic Ingestion ◽

Diffuse Esophageal Spasm ◽

Epiphrenic Diverticulum ◽

Motility Disorders ◽

Esophageal Spasm ◽

Schatzki Ring

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Download Full-text