title: Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing.
abstract: OBJECTIVE
  Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT.
  
  
  METHODS
  Forty previously completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder.
  
  
  RESULTS
  The total group agreement was moderate (κ=0.57; 95% CI: 0.56-0.59) for EPT and fair (κ=0.32; 0.30-0.33) for CLT. Inter-rater agreement between attendings was good (κ=0.68; 0.65-0.71) for EPT and moderate (κ=0.46; 0.43-0.50) for CLT. Inter-rater agreement between fellows was moderate (κ=0.48; 0.45-0.50) for EPT and poor to fair (κ=0.20; 0.17-0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR: 3.3; 95% CI: 2.4-4.5; P<0.0001), and the odds of incorrect identification of a major motility disorder were 3.4 times higher with CLT than with EPT (OR: 3.4; 2.4-5.0; P<0.0001).
  
  
  CONCLUSIONS
  Superior inter-rater agreement and diagnostic accuracy of esophageal motility diagnoses were demonstrated with analysis using EPT over CLT among our selected raters. On the basis of these findings, EPT may be the preferred assessment modality of esophageal motility.
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: Carlson
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ravi
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Arjan J
authors.initials: AJ
authors.lastname: Bredenoord
authors.affiliation: Department of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Donald O
authors.initials: DO
authors.lastname: Castell
authors.affiliation: Department of Medicine, VA North Texas Healthcare System, Dallas, Texas, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Spechler
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Magnus
authors.initials: M
authors.lastname: Halland
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Navya
authors.initials: N
authors.lastname: Kanuri
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Cadman L
authors.initials: CL
authors.lastname: Leggett
authors.affiliation: Department of Digestive Physiology, Hospices Civils de Lyon, Lyon I University and Inserm 1032, Lyon, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Jose B
authors.initials: JB
authors.lastname: Saenz
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Rena
authors.initials: R
authors.lastname: Yadlapati
authors.affiliation: Biostatistics Division, Division of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jody D
authors.initials: JD
authors.lastname: Ciolino
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Fox
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008365:Manometry; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D010528:Peristalsis; D011312:Pressure; D011897:Random Allocation; D012107:Research Design; D012984:Software; D013337:Students, Medical / Q000706:statistics & numerical data*; D000078329:Workforce