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High-resolution manometry improves diagnosis of esophageal motility disorders
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High-resolution manometry was superior to conventional manometry for diagnosing esophageal motility disorders in patients with unexplained dysphagia, according to the results of a randomized trial.
“To date, the superiority of HRM [high-resolution manometry] for the diagnosis of esophageal motility disorders has not been proven with a high level of evidence,” the researchers wrote. “We performed a prospective randomized controlled study with the hypothesis that, in patients with non-obstructive dysphagia, diagnoses of esophageal motility disorders are more frequently correct and confirmed after 6-month follow-up with HRM than with CM [conventional manometry].”
Between March 2011 and March 2013, the researchers prospectively identified 247 adults with unexplained, non-obstructive dysphagia at six tertiary centers in France, and randomly assigned them to undergo either CM or HRM. The intention-to-treat population included 245 patients (99 men; mean age, 58 years; range, 19-94 years), 123 of whom underwent HRM.
Researchers evaluated dysphagia severity using the Sydney questionnaire, and compared initial diagnoses with the proportion of confirmed diagnoses, which were based on clinical outcomes and treatment response at 6 months.
An initial manometric diagnosis of either normal motility or an esophageal motility disorder was more frequently achieved with HRM (97%; 95% CI, 92-99) vs. CM (84%; 95% CI, 77-90). Achalasia was more frequently diagnosed with HRM (26% vs. 12%; P < .01), as were hypermotility or hypomotility disorders (32% vs. 15%; P < .01), whereas absence of motility or nonspecific disorders occurred more frequently with CM (52% vs. 28%; P < .05).
The initial diagnosis was confirmed at 6-month follow-up in 89% (95% CI, 83-94) of the patients who underwent HRM vs. 81% (95% CI, 73-88) of those who underwent CM (P = .07).
The mean duration of procedure and data analysis was shorter with HRM vs. CM (both P < .001), and the mean overall tolerance score was better with CM vs. HRM (P < .01).
“This is the first randomized trial demonstrating that esophageal motility disorders and achalasia in particular were more frequently diagnosed with HRM than with CM,” the researchers concluded. “After 6-month follow-up, esophageal motility disorders diagnoses tended to be more frequently confirmed in the HRM group compared with the CM group even if the difference did not reach statistical significance ... This suggests that HRM might diagnose esophageal motility disorders more consistently than CM.” – by Adam Leitenberger
Disclosure: Roman and two other researchers report they have served as paid consultants for Given Imaging/Covidien/Medtronic.
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