Esophageal Manometry of 2,092 Patients with Esophageal Symptoms in Korean

song, Chi Wook; Jeen, Yoon Tae; Lee, Hong Sik; Jeon, Hoon Jai; Um, Soon Ho; Lee, Sang Woo; Choi, Jai Hyun; Kim, Chang Duck; Ryu, Ho Sang; Hyun, Jin Hai

Abstract

BACKGROUND AND AIMS: Esophageal manometry has gradually become a widely available diagnostic test. However, there are few reports of esophageal manometric results because the standardization of methods has not yet been established. To evaluate prevalence and clinical manifestation of primary esophageal motility disorder (EMD) in Korea, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms.
METHODS
Records from 2,092 patients referred to our manometric laboratory for evaluation of esophageal symptoms between March 1993 and September 1996 were enrolled. Evaluation included baseline esophageal manometry with low compliance pneumohydraulic capillary infusion system and provocation test for esophageal chest pain witb edrophonium and acid infusion.
RESULTS
Among 2,092 patients, 1,205 (58%) patients had normal esophageal motility and 887 (42%) had abnormal motility. Achalasia was present in 5% of abnormal tracings and most frequently associated with dysphagia. Diffuse esophageal spasm (DES) was present in 4% and associated with dysphagia and noncardiac chest pain. Nutcracker esophagus (NUT), hypertensive lower esophageal sphincter (HLES) and nonspecific esophageal motility disorder (NEMD) were present in 16%, 27% and 48% of the patients respectively and associated with chest pain as the predominant symptom. Provocative testing with acid infusion and edrophonium improved the specificity of a diagnosis of esophageal chest pain.
CONCLUSIONS
Primary EMDs were observed in 42% of patient with esophageal symptoms. The most common symptom of achalasia was dysphagia. In the case of DES, dysphagia and noncardiac chest pain were frequent, with NEMD, HLES and NUT the main causes of noncardiac chest pain. However, further studies for the pathogenesis and clinical implications of primary EMDs are necessary.