title: High-resolution manometry correlates of ineffective esophageal motility.
abstract: OBJECTIVE
  There are currently no criteria for ineffective esophageal motility (IEM) and ineffective swallow (IES) in esophageal pressure topography (EPT). Our aims were to use high-resolution manometry metrics to define IEM within the Chicago Classification and to determine the distal contractile integral (DCI) threshold for IES.
  
  
  METHODS
  The EPT of 150 patients with either dysphagia or reflux symptoms were reviewed. Peristaltic function in EPT was defined by the Chicago Classification; the corresponding conventional line tracing (CLT) were reviewed separately. Generalized linear mixed models were used to find thresholds for DCI corresponding to traditionally determined IES and failed swallows. An external validation sample was used to confirm these thresholds.
  
  
  RESULTS
  In terms of swallow subtypes, IES in CLT were a mixture of normal, weak, and failed peristalsis in EPT. A DCI of 450 mm Hg-s-cm was determined to be optimal in predicting IES. In the validation sample, the threshold of 450 mm Hg-s-cm showed strong agreement with CLT determination of IES (positive percent agreement 83%, negative percent agreement 90%). The patient diagnostic level agreement between CLT and EPT was good (78.6% positive percent agreement and 63.9% negative percent agreement), with negative agreement increasing to 92.0% if proximal breaks were excluded.
  
  
  CONCLUSIONS
  The manometric correlate of IEM in EPT is a mixture of failed swallows and weak swallows with breaks in the middle/distal troughs. A DCI value <450 mm Hg-s-cm can be used to predict IES previously defined in CLT. IEM can be defined by >5 swallows with weak/failed peristalsis or with a DCI <450 mm Hg-s-cm.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA. yinglian.xiao@gmail.com
authors.forename: Yinglian
authors.initials: Y
authors.lastname: Xiao
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kwasny
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Zhiyue
authors.initials: Z
authors.lastname: Lin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Nicodème
authors.forename: Chang
authors.initials: C
authors.lastname: Lu
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology; D011237:Predictive Value of Tests; D012984:Software