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Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning

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Abstract

Background

High-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders (EMDs); however, it requires specialized equipment. The development of more accessible screening examinations is expected. We evaluated the utility of barium esophagography (BE) screening using two novel findings to diagnose EMDs.

Methods

Between January 2013 and October 2020, 244 patients with suspected EMDs who underwent both HRM and BE were analyzed. The EMD diagnosis was based on HRM findings using Chicago Classification version 3.0. BE was performed using sequential esophagography with barium sulfate. Three conventional BE findings (air-fluid level, rosary-bead/corkscrew appearance, and absent/weak peristalsis) and two novel BE findings (wave appearance and supra-junctional ballooning) were used for diagnosis.

Results

The sensitivity and specificity of BE screening using the two novel findings and conventional findings to diagnose EMDs were 79.4% and 88%, respectively [area under the receiver-operating characteristic curve (AUC) = 0.837]. Without these novel findings, they were 63.9% and 96%, respectively (AUC = 0.800), respectively. Achalasia was highly correlated with the air-fluid level (88.7%). Absent contractility was highly correlated with absent/weak peristalsis (85.7%). Relatively high correlations were observed between distal esophageal spasm and rosary-bead/corkscrew appearance (60%), and between achalasia and wave appearance (59.7%). The intra-observer reproducibility and inter-observer agreement for individual BE findings were 84.4% and 75%, respectively. Wave appearance was associated with higher integrated relaxation pressure (IRP) and shorter distal latency. Supra-junctional ballooning was associated with higher IRP.

Conclusions

BE screening using two additional novel findings to diagnose EMDs could be useful in general practice.

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References

  1. Katz PO, Dalton CB, Richter JE, et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients. Ann Intern Med. 1987;106:593–7.

    Article  CAS  Google Scholar 

  2. Pandolfino JE, Fox MR, Bredenoord AJ, et al. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21:796–806.

    Article  CAS  Google Scholar 

  3. Inoue H, Sato H, Ikeda H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–64.

    Article  Google Scholar 

  4. Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0((c)). Neurogastroenterol Motil. 2021;33:e14058.

    Article  Google Scholar 

  5. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  CAS  Google Scholar 

  6. Kraft C, Kathpalia P, Baumgardner JM, et al. How to incorporate esophageal manometry teaching in your fellowship program. Gastroenterology. 2019;156:2120–3.

    Article  Google Scholar 

  7. Carroll TL, Werner A, Nahikian K, et al. Rethinking the laryngopharyngeal reflux treatment algorithm: evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease. Laryngoscope. 2017;127(Suppl 6):S1-s13.

    Article  CAS  Google Scholar 

  8. Ott DJ, Richter JE, Chen YM, et al. Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol. 1987;149:307–11.

    Article  CAS  Google Scholar 

  9. Schima W, Stacher G, Pokieser P, et al. Esophageal motor disorders: videofluoroscopic and manometric evaluation–prospective study in 88 symptomatic patients. Radiology. 1992;185:487–91.

    Article  CAS  Google Scholar 

  10. O’Rourke AK, Lazar A, Murphy B, et al. Utility of esophagram versus high-resolution manometry in the detection of esophageal dysmotility. Otolaryngol Head Neck Surg. 2016;154:888–91.

    Article  Google Scholar 

  11. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8.

    Article  CAS  Google Scholar 

  12. Fleiss JLLB, Paik MC. Statistical methods for rates and proportions. 3rd ed. Hoboken: John Wiley & Sons Inc.; 2003.

    Book  Google Scholar 

  13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  Google Scholar 

  14. Schlottmann F, Neto RML, Herbella FAM, et al. Esophageal achalasia: pathophysiology, clinical presentation, and diagnostic evaluation. Am Surg. 2018;84:467–72.

    Article  Google Scholar 

  15. Van Hoeij FB, Ponds FA, Smout AJ, et al. Incidence and costs of achalasia in The Netherlands. Neurogastroenterol Motil. 2018;30:e13195.

    Article  CAS  Google Scholar 

  16. Hamada S, Ihara E, Ikeda H, et al. Clinical characterization of vonoprazan-refractory gastroesophageal reflux disease. Digestion. 2021;102:197–204.

    Article  CAS  Google Scholar 

  17. Kuo P, Holloway RH, Nguyen NQ. Current and future techniques in the evaluation of dysphagia. J Gastroenterol Hepatol. 2012;27:873–81.

    Article  Google Scholar 

  18. Schlottmann F, Herbella FA, Patti MG. Understanding the Chicago classification: from tracings to patients. J Neurogastroenterol Motil. 2017;23:487–94.

    Article  Google Scholar 

  19. Balko RA, Codipilly DC, Ravi K. Minor esophageal functional disorders: are they relevant? Curr Treat Options Gastroenterol. 2020;18:82–96.

    Article  Google Scholar 

  20. Stiennon OA. On the cause of tertiary contractions and related disturbances of the esophagus. Am J Roentgenol Radium Ther Nucl Med. 1968;104:617–24.

    Article  CAS  Google Scholar 

  21. Blonski W, Kumar A, Feldman J, et al. Timed barium swallow: diagnostic role and predictive value in untreated achalasia, esophagogastric junction outflow obstruction, and non-achalasia dysphagia. Am J Gastroenterol. 2018;113:196–203.

    Article  Google Scholar 

  22. Hamada S, Ihara E, Muta K, et al. Onigiri esophagography as a screening test for esophageal motility disorders. J Neurogastroenterol Motil. 2022;28:43–52.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Junji Kishimoto (Center for Clinical and Translational Research at Kyushu University Hospital) for reviewing the statistical methods of this study. The authors would like to thank Editage for English language editing.

Funding

This study was partially supported by the Japan Society for the Promotion of Science KAKENHI (20K08334).

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Authors and Affiliations

  1. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan

    Yoshitaka Hata, Eikichi Ihara, Masafumi Wada, Hirotaka Tsuru, Kazumasa Muta, Yosuke Minoda, Xiaopeng Bai, Mitsuru Esaki, Yoshimasa Tanaka, Takatoshi Chinen, Haruei Ogino, Ryuichi Sakamoto & Yoshihiro Ogawa

  2. Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Eikichi Ihara

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  1. Yoshitaka Hata
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  2. Eikichi Ihara
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  3. Masafumi Wada
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Contributions

YH, EI, and HO contributed to the study conception and design. Material preparation and data collection were performed by YH, MW, HT, KM, XB, YT, and RS. YM and ME performed statistical analysis. YH and EI mainly wrote the manuscript. TC and YO supervised this study and reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eikichi Ihara.

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Conflict of interest

E.I. belongs to an endowed course supported by companies including Ono Pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Otsuka Pharmaceutical Factory, Inc., Fujifilm Medical Co., Ltd., Terumo Corporation, FANCL Corporation, Ohga Pharmacy, and Abbott Japan, LLC. E.I. receives a lecture honorarium from Takeda Pharmaceutical Company. Y.O. conducts collaborative research with Fujifilm Medical Co., Ltd. and FANCL Corporation. The other authors have no conflicts of interest to declare in relation to this study.

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Hata, Y., Ihara, E., Wada, M. et al. Improved esophagography screening for esophageal motility disorders using wave appearance and supra-junctional ballooning. J Gastroenterol 57, 838–847 (2022). https://doi.org/10.1007/s00535-022-01913-4

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  • DOI: https://doi.org/10.1007/s00535-022-01913-4

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