Correlation of High Resolution Esophageal Manometry With Symptoms

Study Overview
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Brief Summary
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High Resolution Manometry is a new technology that utilizes 36 solid state sensors on a thin catheter spaced at 1-cm intervals. One can more effectively measure the pressure of the esophagus. It includes a sophisticated software to display the pressures data as color topography plot using time, length of the esophagus and pressure within the entire esophagus. It is unclear if this technology improvement actually correlates with patient's symptoms.

Detailed Description
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In a 2007 retrospective study performed using this technology, 400 subjects referred to the motility lab underwent high resolution manometry (HRM) for complaints of dysphasia, gastroesophageal reflux disease, chest pain and miscellaneous complaints. HRM offered greater detail of individual contracting segments of the esophagus, including the duration of contraction and propagation of individual contractions. For example, a new subclass of achalasia was defined by HRM. In this classification, achalasia is divided into types 1, 2 and 3. Type 1 corresponds to classic achalasia (complete esophageal motor failure), type 2 is a compression achalasia (simultaneous panesophageal pressurization with aperistalsis), and type 3 is spastic achalasia with aperistalsis (100% spasm). However, it is unclear if this categorization represents a spectrum of disease among patients with achalasia, or it represents distinct subgroups of patients with different symptom presentation and etiology. This study will attempt to correlate the data from HRM to patient's chief compliants, symptom severity, and clinical presentation.

Official Title
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Correlation of High Resolution Esophageal Manometry With Symptoms

Conditions
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Achalasia, Dysphagia, GERD, Chest Pain, Post Fundoplication

Intervention / Treatment
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* Procedure: High Resolution Manometry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects who are referred to the motility lab to undergoing esophageal HRM for various clinical indications. Exclusion Criteria: Pregnancy Unable to give consent Less than 18 years old Prisoner

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Type I achalasia<br>classic achalasia: complete esophageal motor failure | Procedure: High Resolution Manometry<br>* High Resolution Manometry which uses 36 solid state sensors spaced at 1-cm intervals, positioned from the hypopharynx to the stomach.<br>* Other names: Achalasia;|
| Type II achalasia<br>compression achalasia: simultaneous panesophageal pressurization with aperistalsis | Procedure: High Resolution Manometry<br>* High Resolution Manometry which uses 36 solid state sensors spaced at 1-cm intervals, positioned from the hypopharynx to the stomach.<br>* Other names: Achalasia;|
| Type III achalasia<br>spastic achalasia with aperistalsis: 100% spasm | Procedure: High Resolution Manometry<br>* High Resolution Manometry which uses 36 solid state sensors spaced at 1-cm intervals, positioned from the hypopharynx to the stomach.<br>* Other names: Achalasia;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences and similarities in patients with achalasia | To determine the differences and similarities in the clinical presentation of patients with type 1, 2 and 3 achalasia based on the Chicago classification for HRM | at 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Esophageal dysmotility in patients with dysphagia and GERD symptoms | To determine the prevalence of esophageal dysmotility using the Chicago classification based on primary chief complaints. | at 24 months | 
| HRM parameters | To determine if HRM parameters reflect esophageal physiology between contractile strength of the esophagus and GEJ residual pressure obstructing esophageal flow. | at 24 months | 
| Esophageal dysmotility in patients with postfundoplication compliants | To determine the prevalence of esophageal dysmotility using the Chicago classification based in patients with postfundoplication complaints. | at 24 months | 
| Correlation between HRM and symptoms | To determine if HRM parameters reflect symptom presentations. | At 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High Resolution Manometry, achalasia, dysphagia, GERD, chest pain, Post fundoplication