Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India.
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Date
2010-11
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Abstract
Background We studied the spectrum of motor dysphagia in a northern Indian tertiary referral center.
Methods In this retrospective study, consecutive patients
with motor dysphagia referred to the Gastrointestinal
Pathophysiology and Motility Laboratory from 2002 to 2007
were evaluated clinically and with eight-channel water-perfusion
manometry. Causes of dysphagia were diagnosed using
standard criteria.
Results Of 250 patients (age 41.3 [15.0] years, 146 men),
193 (77%) had achalasia cardia (AC) and 57 (23%) had
other causes (11, 4.4%: diffuse esophageal spasm [DES]; 9,
3.6%: hypertensive lower esophageal sphincter [Hy LES]);
manometry was normal in 37 patients. Twenty-seven patients
(14%) had vigorous AC. Duration of dysphagia at presentation
was longer in those with AC and Hy LES than in
normal manometry (NM) (21 months [1–180] vs. 6 [1–360],
p = 0.000; 24 months [7–48] vs. 6 [1–360], p = 0.015). Regurgitation
and bolus obstruction were more frequent in those
with AC than in NM (89/154, 57.79% vs. 3/27, 11.11%,
p = 0.000001). Heartburn was less frequent in patients with
AC than in others (AC: 4/146, 2.73% vs. normal: 4/27, 14.8%
[p = 0.02] and others: 3/15, 20% [p = 0.018]). Chest pain
was reported by 74/135 (54.8%) classic and 12/19 (63.2%)
vigorous AC (p = NS). Patients with NM had lower LES
pressure than those with classic AC, Hy LES and vigorous
AC (p < 0.0001 in each case). Patients with DES had lower
LES pressure than in classic AC, Hy LES and vigorous AC
(p = 0.043, p < 0.0001, and p = 0.002, respectively). Patients
with classic AC had lower LES pressure than in Hy LES and
vigorous AC (p = 0.024, p = 0.001, respectively).
Conclusion Classic AC was the commonest cause of motor dysphagia in our center. AC was associated with higher LES pressure, longer duration of dysphagia, frequent regurgitation and bolus obstruction.
Description
Keywords
Achalasia cardia, diffuse esophageal spasm, esophageal manometry, hypertensive lower esophageal sphincter
Citation
Misra Asha, Chourasia Dipti, Ghoshal Uday C. Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India. Indian Journal of Gastroenterology. 2010 Jan-Feb; 29(1): 18-22.