High Resolution Manometry Patterns Distinguish Acid Sensitivity in Non-cardiac Chest Pain

Overview

Journal Neurogastroenterol Motil

Specialties Gastroenterology
Neurology

Date 2011 Sep 21

PMID 21929566

Citations 13

Authors

V M Kushnir

C Prakash Gyawali

Affiliations

Soon will be listed here.

Abstract

Background: High resolution manometry (HRM) has demonstrated two distinct smooth muscle contraction segments in the esophageal body; changes in these segments typify certain esophageal disorders. We investigated segmental characteristics in subgroups of non-cardiac chest pain (NCCP).

Methods: 32 NCCP subjects were segregated into a GERD group (ambulatory pH testing off antisecretory therapy showing elevated total acid exposure time, AET≥4.0% and positive symptom association probability, SAP) and an acid sensitive group (normal AET and positive SAP). HRM Clouse plots were analyzed; smooth muscle segment lengths, pressure amplitude peaks were measured for segment 2 and segment 3 (proximal and distal smooth muscle segments). Pressure volumes were determined in mmHg cm(-1) s(-1) for each peristaltic segment, and ratios of segment 3:segment 2 calculated. Values were compared to a cohort of 14 normal controls.

Key Results: A distinctive shift in peak contraction amplitude to segment 3 was evident in the acid sensitive group (segment 2, 100.03±11.06mmHg, segment 3, 145.23± 10.29mmHg, P=0.006). Pressure volumes were similarly shifted to segment 3 (segment 2: 855.3 ± 135.1 mmHg cm(-1) s(-1) , segment 3: 2115.2±218.6 mmHg cm(-1) s(-1) , P<0.005). In contrast, peak amplitude and pressure volume were near equal in the two segments in GERD and control groups. A threshold segment 3:segment 2 pressure volume ratio of 1.9 had the best performance characteristic for segregating acid sensitivity subjects from all GERD and control subjects.

Conclusions & Inferences: Shift in contractile vigor to the third peristaltic segment may be seen in acid sensitive subjects. HRM characteristics of smooth muscle contraction segments are of value in making this determination.

Citing Articles

Chronic Cough Is Associated With Long Breaks in Esophageal Peristaltic Integrity on High-resolution Manometry.

Bennett M, Patel A, Sainani N, Wang D, Sayuk G, Gyawali C J Neurogastroenterol Motil. 2018; 24(3):387-394.

PMID: 29969856 PMC: 6034665. DOI: 10.5056/jnm17126.

What Is the Impact of High-Resolution Manometry in the Functional Diagnostic Workup of Gastroesophageal Reflux Disease?.

Keller J Visc Med. 2018; 34(2):101-108.

PMID: 29888238 PMC: 5981626. DOI: 10.1159/000486883.

Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry.

Quader F, Reddy C, Patel A, Gyawali C Am J Physiol Gastrointest Liver Physiol. 2017; 313(1):G73-G79.

PMID: 28408642 PMC: 5538833. DOI: 10.1152/ajpgi.00091.2017.

Comparison of motor diagnoses by Chicago Classification versions 2.0 and 3.0 on esophageal high-resolution manometry.

Patel A, Cassell B, Sainani N, Wang D, Shahid B, Bennett M Neurogastroenterol Motil. 2017; 29(7).

PMID: 28229560 PMC: 5466481. DOI: 10.1111/nmo.13042.

Impact of symptom burden and health-related quality of life (HRQOL) on esophageal motor diagnoses.

Reddy C, Patel A, Gyawali C Neurogastroenterol Motil. 2016; 29(4).

PMID: 27723241 PMC: 5367979. DOI: 10.1111/nmo.12970.

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