title: Long-term Outcomes of Patients With Normal or Minor Motor Function Abnormalities Detected by High-resolution Esophageal Manometry.
abstract: OBJECTIVE
  High-resolution manometry (HRM) expands recognition of minor esophageal motor abnormalities, but the clinical significance of these is unclear. We aimed to determine the outcomes of minor esophageal motor abnormalities.
  
  
  METHODS
  We reviewed HRM tracings from patients who underwent esophageal manometry at Northwestern Memorial Hospital from July 2004 through October 2005 by using the Chicago classification (version 2.0). We identified 301 patients with normal findings or minor manometric abnormalities (weak peristalsis, hypertensive peristalsis, frequent failed peristalsis, or rapid contractions with normal latency). Ninety-eight patients participated in a phone survey in which they were asked questions from the impact dysphagia questionnaire (mean follow-up period, 6 years 5 months).
  
  
  RESULTS
  Of 301 patients assessed, 166 had normal findings from HRM, 82 had weak peristalsis, 34 had hypertensive peristalsis, 17 had frequent failed peristalsis, and 2 had rapid contractions with normal latency. The primary indications for HRM of dysphagia (44%) and gastroesophageal reflux disease (63%) were unrelated to manometric findings. There were no endoscopic or videofluoroscopic differences between patients with minor manometric abnormalities. Of 98 patients with follow-up, findings from HRM were normal in 63, weak peristalsis was observed in 23, hypertensive peristalsis was observed in 10, and frequent failed peristalsis was observed in 2. No patients underwent surgical myotomy, pneumatic dilation, or botulinum toxin injection. Use of proton pump inhibitors and rates of fundoplication were similar, regardless of manometric findings. Sixteen patients (16%) had significant dysphagia at follow-up; hypertensive peristalsis was the most likely to be symptomatic.
  
  
  CONCLUSIONS
  Patients with normal and minor esophageal motor abnormalities report minimal symptoms and have few medical interventions related to esophageal dysfunction during long-term follow-up. Therefore, identification of normal and minor motor function is likely a good prognostic indicator.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: ravi.karthik@mayo.edu.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ravi
authors.affiliation: Department of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Laurel
authors.initials: L
authors.lastname: Friesen
authors.affiliation: Department of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Rachel
authors.initials: R
authors.lastname: Issaka
authors.affiliation: Department of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Department of Gastroenterology and Hepatology, Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000473:pathology*; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chicago Classification; Minor Manometric Abnormalities; Nutcracker Esophagus; Weak Peristalsis