PMID- 35189822
OWN - NLM
STAT- MEDLINE
DCOM- 20220223
LR  - 20220225
IS  - 1471-230X (Electronic)
IS  - 1471-230X (Linking)
VI  - 22
IP  - 1
DP  - 2022 Feb 21
TI  - Elevated average maximum intrabolus pressure on high-resolution manometry is 
      associated with esophageal dysmotility and delayed esophageal emptying on timed 
      barium esophagram.
PG  - 74
LID - 10.1186/s12876-022-02165-5 [doi]
LID - 74
AB  - BACKGROUND: Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) 
      portrays the compartmentalized force on a bolus during esophageal peristalsis. 
      HRM may be a reliable screening tool for esophageal dysmotility in patients with 
      elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a 
      validated measure of esophageal emptying disorders, such as esophagogastric 
      junction outflow obstruction and achalasia. This study aimed to determine if an 
      elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed 
      esophageal emptying on TBE. METHODS: A retrospective analysis of all HRM 
      (unweighted sample n = 155) performed at a tertiary referral center from 
      09/2015-03/2017 yielded a case group (n = 114) with abnormal AM-IBP and a control 
      group (n = 41) with a normal AM-IBP (pressure < 17 mmHg) as consistent with 
      Chicago Classification 3. All patients received a standardized TBE, with 
      abnormalities classified as greater than 1 cm of retained residual liquid barium 
      in the esophagus at 1 and 5 min or as tablet retention after 5 min. RESULTS: 
      AM-IBP was significantly related to liquid barium retention (p = 0.003) and 
      tablet arrest on timed barium esophagram (p = 0.011). A logistic regression model 
      correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP 
      correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with 
      elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% 
      vs. 70.7% respectively; p < 0.001), particularly esophagogastric junction outflow 
      obstruction disorders. Elevated AM-IBP was associated with incomplete liquid 
      bolus transit on impedance analysis (p = 0.002). CONCLUSIONS: Our findings 
      demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of 
      esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 
      20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or 
      barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding 
      supports the recent incorporation of IBP in Chicago Classification v4.0.
CI  - (c) 2022. The Author(s).
FAU - Madigan, Katelyn E
AU  - Madigan KE
AD  - Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, 
      Winston-Salem, NC, 27157, USA. kmadigan@wakehealth.edu.
FAU - Smith, J Shawn
AU  - Smith JS
AD  - Department of Medicine, Prisma Health, Greenville School of Medicine, Greenville, 
      USA.
FAU - Evans, Joni K
AU  - Evans JK
AD  - Department of Public Health Sciences, Wake Forest School of Medicine, 
      Winston-Salem, USA.
FAU - Clayton, Steven B
AU  - Clayton SB
AD  - Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, 
      Winston-Salem, NC, 27157, USA.
AD  - Department of Medicine, Section on Gastroenterology, Wake Forest School of 
      Medicine, Winston-Salem, USA.
AD  - Department of Medicine, Section on Gastroenterology, Greenville School of 
      Medicine, Greenville, USA.
LA  - eng
PT  - Journal Article
DEP - 20220221
PL  - England
TA  - BMC Gastroenterol
JT  - BMC gastroenterology
JID - 100968547
RN  - 24GP945V5T (Barium)
SB  - IM
MH  - Barium
MH  - *Esophageal Achalasia/diagnosis
MH  - *Esophageal Motility Disorders/diagnostic imaging
MH  - Humans
MH  - Manometry
MH  - Retrospective Studies
PMC - PMC8859877
OTO - NOTNLM
OT  - Esophageal dysmotility
OT  - High-resolution manometry
OT  - Timed barium esophagram
COIS- None of the authors have any potential financial or non-financial conflicts to 
      disclose.
EDAT- 2022/02/23 06:00
MHDA- 2022/02/24 06:00
PMCR- 2022/02/21
CRDT- 2022/02/22 05:42
PHST- 2021/11/09 00:00 [received]
PHST- 2022/02/04 00:00 [accepted]
PHST- 2022/02/22 05:42 [entrez]
PHST- 2022/02/23 06:00 [pubmed]
PHST- 2022/02/24 06:00 [medline]
PHST- 2022/02/21 00:00 [pmc-release]
AID - 10.1186/s12876-022-02165-5 [pii]
AID - 2165 [pii]
AID - 10.1186/s12876-022-02165-5 [doi]
PST - epublish
SO  - BMC Gastroenterol. 2022 Feb 21;22(1):74. doi: 10.1186/s12876-022-02165-5.