Abstract
Abstract
Background
Primary aperistalsis is an uncommon finding on high resolution manometry (HRM), and has been linked to autoimmune disorders. The goal of the study is to describe and explore clinical spectrum and presentation of this group of patients.
Methods
An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients with aperistalsis between 08/01/2016 and the 11/10/2017. HRM studies were reevaluated. Patients with poor studies, or insufficient clinical information were excluded. Patients with history of previous foregut surgery or esophagram consistent with achalasia were also excluded.
Results
A total of 1225 patients underwent HRM during the study period of which 36 (2.9%) met inclusion criteria and form the cohort of this study. In this group 30 patients also had UGI contrast study and endoscopy, while foregut symptom questionnaire was available for 24 patients. There were 16 (44%) females. The mean age was 57.6(± 13.58) Yrs. and mean BMI 26.28 (± 5.4) kg/m2. More than half (21/36) of the patients were undergoing lung transplant evaluation. 26 patients (72.2%) had history of autoimmune or immune mediated diseases (including 6 with Scleroderma and 11 interstitial lung disease). On symptom questionnaire, 75% (18/24) of patients reported heartburn, and 50% (12/24) reported dysphagia while 9 (37.5%) patients reported both. 9 of 36 patients had hiatal hernia on HRM, median IRP 4s was 4.8mmHg, average LESP was 21mmHg. On ambulatory pH-monitoring, 9/19 had pathological DeMeester scores. Endoscopic biopsy results showed columnar intestinal metaplasia in 16.7% (5/30) of patients. Esophageal candidiasis was confirmed in 2 (6.7%) cases. On esophagogram two (6.7%) were additionally diagnosed with Zenker's diverticula.
Conclusion
Aperistalsis on HRM is rare and covers a wide array of diseases; the usual clinical presentation is reflux and/or dysphagia. Interestingly only half these patients with absent motility have dysphagia. In our study a large number of patients were undergoing pre-lung transplant evaluation, this could either be due to causative underlying disease process or a result of deranged pulmonary dynamics affecting esophageal motility.
Disclosure
All authors have declared no conflicts of interest.