Fox, M.; Hebbard, G.; Brasseur, J.; Schwizer, W.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA42
Academic Journal
Background: Conventional manometry CM) with 5-8 oesophageal pressure channels and a lower oesophageal sphincter LOS) sleeve sensor is limited by poor resolution. HRM techniques with 21-32 pressure channels may increase diagnostic accuracy. Aim: To analyse quantitatively whether HRM improves the assessment of motility compared to CM, and to determine qualitatively the situations in which HRM provides clinically important information not obtained by conventional investigation including CM. Method: Control subjects and patients with dysphagia underwent HRM. 95 records were reviewed independently by two blinded physicians using both limited CM (pull-through plus 6 recording sites) and HRM analysis (all 32 sites). Further HRM records from dysphagic patients with non-diagnostic endoscopy and radiology were compared to the limited CM analysis to identify the additional information leading to positive diagnosis provided by HRM. Findings: Receiver-operating curve (ROC) analysis revealed for HRM at a sensitivity level of 90% a specificity of 100%, whereas for CMa specificity of 89% was associated with a sensitivity of 70%. Qualitative analysis demonstrated that HRM provided positive diagnoses in cases where conventional tests including CM were nondiagnostic. Advantages included: (i) detection of Iocalised disturbances of peristalsis (eg sub-mucosal leiomyoma); (ii) ability to locate and follow LOS movement during esophageal spasm without loss of detail (eg vigorous achalasia with pseudo-relaxation); and (iii) detailed analyses of LOS pressure topography (eg dysfunction post-fundoplication). Conclusion: HRM is more accurate than CM and identifies clinically important peristaltic and LOS dysfunction not detected by conventional investigations including CM.


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