title: The relationship between dysphagia, pump function, and lower esophageal sphincter pressures on high-resolution manometry.
abstract: BACKGROUND
  Study objective was to compare high-resolution impedance manometry (HRIM) findings between patients with and without dysphagia.
  
  
  METHODS
  After Institutional Review Board approval, a prospectively maintained database was reviewed to identify patients who underwent HRIM. Patients without upper endoscopy within 7 days of manometry, patients with achalasia, history of previous foregut surgery, esophageal strictures, or a large hiatus hernia were excluded. A new parameter called lower esophageal sphincter pressure integral (LESPI) was compared between patients with and without dysphagia. For subanalysis, subjects were categorized: (a) group A: no dysphagia and <60% hypocontractile or absent waves, (b) group B: dysphagia and <60% hypocontractile or absent waves, and (c) group C: ≥ 60% hypocontractile or absent waves.
  
  
  RESULTS
  One hundred thirteen patients satisfied study criteria. Patients with dysphagia had a significantly higher LESPI and distal contractile integral (DCI). On multivariate regression analysis, the following were associated with dysphagia: (a) ≥ 60% hypocontractile or absent waves, (b) LESPI >400 mmHg s cm, and (c) DCI >3,000 mmHg s cm. However, 32% of patients with <60% hypocontractile or absent waves (group B) had dysphagia. These patients had a significantly higher DCI and LESPI than group A. Group C had a significantly lower DCI than all other patients.
  
  
  CONCLUSIONS
  Dysphagia in patients with ≥ 60% hypocontractile or absent waves is indicative of an intrinsic pump failure as they have low DCI, while dysphagia in patients with <60% hypocontractile or absent waves is more indicative of significant outflow obstruction as they have high LESPI and integrated relaxation pressure.
authors.affiliation: Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131, USA.
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sundaram
authors.forename: Ananth
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000503:physiopathology*; D016099:Endoscopy, Gastrointestinal; D004931:Esophageal Achalasia / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D011312:Pressure; D011446:Prospective Studies; D015203:Reproducibility of Results