A PROSPECTIVE OBSERVATIONAL STUDY OF HIGH RESOLUTION MANOMETRY (HRM) FINDINGS AT WEEK - 4 IN PATIENTS WITH CORROSIVE ESOPHAGEAL INJURY ATTENDING TERTIARY CARE CENTER
Authors: Jagadeesh Manikanta Dharavath , Ratnakar Kini P. , Premkumar K. 
Published: December 2024

Background & Aim: Corrosive ingestion remains a significant cause of esophageal injury, often resulting in acute inflammation, fibrosis, and
long-term motility dysfunction. While endoscopic evaluation can identify structural abnormalities such as strictures, High Resolution Manometry
(HRM) provides a detailed functional assessment of the esophagus, enabling detection of motility disorders that may not be apparent on imaging.
This study aims to assess HRM findings at week four in patients with corrosive esophageal injury, characterize motility patterns and correlate them
with clinical symptoms and evaluate the response to treatment over six months. Methods: Seventy patients who meet the inclusion and exclusion
criteria will be enrolled in the study. Adetailed history and clinical examination will be conducted. Oesophagogastroduodenoscopy (OGD) will be
performed within 3 days of corrosive ingestion, followed by a repeat OGD at 4 weeks post-ingestion according to institutional protocol. Patients
with persistent symptoms despite normal repeat OGD will be selected for HRM. HRM will be performed at week 4 with patient consent to assess
esophageal motility. Parameters such as Integrated Relaxation Pressure (IRP), Distal Latency (DL), Distal Contractile Index (DCI), Contraction
Vigour, Contraction Pattern, and Intrabolus Pressure Pattern (IBP) will be measured and analyzed for motility abnormalities. These findings will be
correlated with clinical symptoms. Patients will be followed for 6 months to assess the treatment response. Results: The study included 70 patients
with a mean age of 43.24 ± 15.16 years. The majority were male (62.9%), and the most common corrosive ingested was acid (58.6%). Esophageal
injuries were most frequently classified as Grade 2A (48.57%), followed by Grade 1 (32.85%). A high prevalence of HRM abnormalities was
observed, with 70% of patients exhibiting motility dysfunction. Ineffective esophageal motility (IEM) was the most common abnormality (40%),
followed by esophagogastric junction (EGJ) outflow obstruction (10%). Among patients with HRM abnormalities, 28 had a significantly reduced
distal contractile index (DCI), and 7 had elevated integrated relaxation pressure (IRP). The majority of patients with HRM abnormalities (48.48%)
showed failed swallows. Symptoms like dysphagia were common across HRM abnormalities, especially in absent contractility, distal esophageal
spasm, and EGJ outflow obstruction. GERD was most prevalent in patients with normal HRM findings and Ineffective Esophageal Motility.
Treatment response at 6 months varied; 15.71% achieved complete resolution, with 65.71% showing partial improvement. Patients with EGJ
outflow obstruction had the lowest response rate. These results underscore the heterogeneity of esophageal motility dysfunction following
corrosive injury and the variable treatment outcomes. Conclusion: This study highlights the high prevalence of esophageal motility abnormalities
in corrosive esophageal injuries, with ineffective motility and EGJ outflow obstruction being most common. High-resolution manometry was
essential in detecting patterns of motility dysfunction, swallow vigor, and integrity. Dysphagia was the most frequent symptom, closely linked to
specific HRM abnormalities. Treatment response at 6 months varied, mostly showing partial response. These findings emphasize the need for
personalized treatment strategies guided by HRM to improve patient outcomes.