Introduction

Ineffective esophageal motility (IEM) has been associated with higher esophageal reflux burden in the context of gastroesophageal reflux disease (GERD). However, the association of IEM with acid exposure time (AET) is not perfect and its true clinical relevance remains unclear. Additionally, although contraction reserve (CR) assesses the ability of the esophageal smooth muscle to augment contraction when challenged and higher CR ratios have been shown to correlate with decreased AETs in nonerosive GERD, there is still limited data in the context of IEM. We aimed to evaluate the association between CR, in IEM and normal esophageal high-resolution manometry (HRM) patients, and AET measured by 24h-ambulatory reflux monitoring (ARM).

Aims & Methods

Retrospective cohort-study that assessed adult patients submitted to HRM with a 36 – channel solid state probe (Manoscan®) and ARM (Diggitrapper^TM) off acid suppressive therapy for evaluation of GERD symptoms between 2020-2022. Patients with IEM, according to Chicago Classification 4.0, and a control group adjusted for age and sex with normal HRM were included. Single swallows and multiple rapid swallows (MRS) were evaluated using Manoview® software and parameters including respiratory minimum basal Lower Esophageal Sphincter Pressure (minLESP), respiratory mean basal LESP (meLESP), median residual LESP (rLESP) and distal contractile integral (DCI) to determine CR were analysed. CR was present when the ratio between MRS DCI and mean single swallow DCI (sDCI) was >1. ARM parameters were assessed and total AET >6% was considered pathologic. The relationship between HRM parameters and AET, between IEM and control group and within each group was analyzed.

Results

From 185 patients who underwent concomitant HRM and ARM for GERD, 40 patients with IEM and 40 with normal HRM were identified. Median rLESP (8.5 vs 7.8, P=0.870) was not significantly different between groups, respectively. However, minLESP (11.2 vs 12.6, P=0.048), meLESP (18.2 vs 21.1, P=0.008), median sDCI (562.5 vs 1604.5, P<0.001), median MRS DCI (589 vs 1677.0, P<0.001), absence of CR (17.5% vs 55%, P=0.001), median AET (6.3 vs 2.3, P=0.025) and proportion of pathologic AET (52.5% vs 12.5%, P<0.001), were significantly different between groups, respectively. Patients without CR, with IEM or normal HRM, had significantly higher proportions of pathologic AET than patients with preserved CR (72.7% vs 27.7%, P=0.01; 42.8% vs 6.1%, P=0.03, respectively).

Conclusion

The absence of contraction reserve is associated with pathologic AET both in IEM and normal HRM patients, having IEM patients a higher burden of pathologic AET than normal HRM group.

Introduction

Evidence is scarce regarding the impact of overweight and obesity on the interpretation of high-resolution esophageal manometry (HREM) parameters. We aimed to investigate whether the presence of overweight and/or obesity influences the HREM parameters.

Aims & Methods

Retrospective cohort study including adult patients undergoing HREM (Manoscan® 36-sensor probe) between 2019-2022, regardless of the indication, with measurement of height and weight at the time of HREM. A HREM diagnosis was obtained according to the Chicago 4.0 classification and the following HREM parameters were collected: esophageal length, length and type of esophagogastric junction (EGJ), presence and extent of hiatal hernia, minimum basal, mean and residual lower esophageal sphincter pressures, basal and residual upper esophageal sphincter pressures, percentage of failed, weak, ineffective, with pressurization, premature, fragmented, intact, hypercontractile swallows and mean and after multiple rapid swallows distal contractile integral. Body mass index (BMI) was calculated, and patients were categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9) and obesity (≥30). The relationship between BMI and its categories with the HREM parameters was evaluated.

Results

A total of 249 patients were included, mostly women (59.8%) with a mean age of 56 ± 14 years. The median BMI was 26 (IQR 5) kg/m2 and 115 (46.2%) patients were overweight, 91 (45.7%) normal weight and 43 (17.3%) obese. A normal HREM (51.8%), followed by ineffective esophageal motility (21.7%) and EGJ outflow obstruction (8.8%) were the most frequent HREM diagnoses. There were no statistically significant differences between the presence of overweight and/or obesity and the HREM parameters evaluated, regardless of the HREM diagnosis.

Conclusion

Overweight and obesity do not seem to influence HREM parameters, so its interpretation should not be influenced by these factors.

Introduction

Gastroparesis is common in patients with Diabetes mellitus, especially in those with poor glycemic control. Due to this association, diabetic patients are at risk of prolonged gastric transit time (PGTT) when undergoing small-bowel capsule endoscopy (SBCE).

Aims & Methods

In this investigation we aimed to assess if there was an association between hemoglobin A1c levels and PGTT in diabetic patients undergoing SBCE.
We have conducted a single-center retrospective study including all consecutive diabetic patients undergoing SBCE for two years. Patients without a valid hemoglobin A1c measurement within 3 months from SBCE were excluded. The assessed outcome was PGTT (defined as SBCE remaining in the stomach for >1h, requiring prokinetic administration and/or endoscopically assisted capsule delivery into the duodenum). Possible confounders – age, gender, inpatient status, smoking habits, diagnosis of IBD, thyroid disease, prokinetics or antidepressants regular usage - were also assessed.

Results

Final sample included 77 patients, 40 (51.9%) of them males, with a mean age of 70±10 years. PGTT occurred in 33 (42.9%) individuals. Mean hemoglobin A1c levels were significantly higher in diabetic patients with PGTT (7.4±0.8% vs 6.5±0.8%; p<0.001). In a multivariate analysis including significant confounders, hemoglobin A1c levels were still an independent predictor of PGTT (B=1.35; p<0.001). Single-handedly, hemoglobin A1c levels demonstrated very good acuity in predicting PGTT (AUC=0.80; p<0.001), with an optimal cut-off of HbA1c ≥6.8% (sensitivity 81% and specificity 73%).

Conclusion

Hemoglobin A1c levels significantly influenced the occurrence of PGTT in diabetic patients undergoing SBCE. This may eventually allow the performance of preemptive measurements to avoid PGTT in diabetic patients with poor glycemic control.

Introduction

Suspected foreign body ingestion and food bolus impaction are common indications for urgent esophagogastroduodenoscopy. Nevertheless, most of the ingested foreign bodies (80 to 90%) pass spontaneously throughout the gastrointestinal tract. In 2022, the Decision-To-Scope (DTS) Score was developed, revealing an excellent accuracy in predicting foreign bodies in the esophagus.

Aims & Methods

Our aim was to prospectively evaluate the diagnostic accuracy of the DTS-Score.
We have prospectively included consecutive patients admitted for suspected foreign body in the upper gastrointestinal tract, for a 6-month period. Previously to endoscopic evaluation, the DTS-score - time since ingestion < 6 hours (+1pt); absence of any meal since the suspected ingestion (+2pts); dysphagia (+3pts); odynophagia (+1pt) and drooling (+4pts) - was applied in each patient. The maximal possible value was 11 points, with a DTS-Score ≥5 being considered to assign a high probability of endoscopic confirmation of the foreign body.

Results

Final sample included 47 patients, from which 26 (55.3%) were females, with a mean age of 60±16 years. From these, most (n=42; 91.5%) were evaluated for accidental ingestion of food-related foreign bodies (fish or chicken bones) or suspected food bolus impaction. A DTS-Score ≥5 was calculated in 11 (23.4%) of the patients, with an esophageal foreign body being confirmed in 12 (25.5%) of them. DTS-score presented an excellent accuracy in predicting the endoscopic confirmation of a foreign body in the esophagus (AUC=0.94; 95%CI 0.85-1.00; p<0.001). The originally defined cut-off (DTS-Score ≥5) presented a specificity of 97.1%, a sensitivity of 83.3%, a positive predictive value of 90.9% and a negative predictive value of 94.4%.

Conclusion

When prospectively applied, the DTS-score demonstrated an excellent acuity in stratifying the probability of endoscopic confirmation of a suspected foreign body in the esophagus. This tool may be included in future clinical algorithms for suspected foreign bodies ingestion.

Introduction

Peristaltic reserve is the normal augmentation of peristaltic contraction amplitude at the end of a series of multiple-rapid swallows (MRS). Normal peristaltic reserve in patients with ineffective esophageal motility (IEM) has been reported to a predictor of good outcome after fundoplication. Conversely, absent peristaltic reserve following MRS is associated with poor esophageal clearance.

Aims & Methods

Aim: Evaluate esophageal acid exposure and mean nocturnal baseline impedance (MNBI) in patients with IEM and patients with normal motility with and without peristaltic reserve.
Methods: Patients undergoing high-resolution esophageal manometry (HRM) and 24-h impedance-pH monitoring (24h-Imp-pH) were classified as having IEM or normal esophageal manometry according to Chicago 4.0 criteria. Peristaltic reserve was declared present (PR+) if distal contraction integral (DCI) following a series of 4x5ml rapid swallows >25% greater than the average DCI following 10 single 5ml swallows. We compared esophageal acid exposure (% time pH<4), number of reflux episodes and MNBI in patients with IEM/normal motility with (PR+) and without (PR-) peristaltic reserve.

Results

Between February 2020 and December 2022 we identified 220 patients (132;60% females, avg (±SD) age 54 (±15) years with IEM (49;22%) and normal motility (171;78%). Esophageal acid exposure, number of reflux episodes and MNBI are summarized below:

Conclusion

Absent peristaltic reserve combined with ineffective esophageal motility is associated with higher esophageal acid exposure and lower mean nocturnal baseline impedance suggesting that patients with IEM and absent peristaltic reserve have a more severe form of GERD compared to patients with normal motility with normal peristaltic reserve.

Disclosure

RT - speakers bureau and educational programs of Laborie Inc.

Introduction

The impact of advanced age on esophageal motility remains relatively underexplored, particularly using updated diagnostic protocols.

Aims & Methods

To evaluate esophageal motility findings, indications, success rate, and diagnostic yields of high-resolution manometry (HRM) in elderly patients. A retrospective multicenter study was conducted across six tertiary medical centers between 2022 and 2024. HRM diagnoses were based on the Chicago Classification v4.0.

Results

1146 patients were included. Dysphagia was the most common indication among elderly patients (≥75 years: 69.0% vs. <75 years: 45.2%, p<0.001). The success rate of HRM was similar (91.7% vs. 90.0%, p=0.575). Elderly patients exhibited higher rates of type III achalasia (6.1% vs. 1.2%, p<0.001), EGJ outflow obstruction (13.6% vs. 3.1%, p<0.001), and hypercontractile esophagus (5.3% vs. 2.5%, p<0.001). Diagnostic yield increased with age for any motility disorder (p<0.01), major motility disorders (p<0.001), and disorders of EGJ outflow. Stratification by the novel elderly definition (>75) revealed increased prevalence of major motility disorders (≥75 years: 43.6% vs. 65–74 years: 28.0% vs. <65 years: 20.7%, p<0.001).

Conclusion

There is a higher prevalence of motility disorders observed in older populations, validating the novel definition of elderly (≥75 years). This demonstrates the need for age-specific diagnostic and therapeutic approaches for esophageal motility disorders.

Disclosure

None