Diagnostic efficacy of dysphagia in patients with high resolutıon manometry

High resolution manometry (HRM) provides more data with more frequently placed sensors and thus enables better evaluation of the motor functions of the esophagus. Measurement of bolus transit based on impedance is a method that shows whether disorders of the esophagus determined manometrically present any obstacle to transition of the bite within the esophagus. Most dysphagia patients where organic causes have been ruled out, are evaluated as normal based on conventional manometry, and the cause of dysphagia cannot be defined.This study aimed to investigate the efficiency of combined impedance and HRM use in determining the etiology of dysphagia. In addition, the value of new diagnostic criteria used in HRM in diagnosis of dysphagia was studied.Sixty-one patients who applied with dysphagia were evaluated with water-perfusion HRM and concomitant impedance system for esophageal motor function deficits and bolus transit. During the analysis, channels in manometric data that exceeded those of the classical manometry were excluded and classical manometric evaluations were also performed.Of the 61 patients that were subjected to manometric evaluation, 35 (57%) were female and 26 (43%) were male. The mean age of the patients was 47±12 years.Based on the data from classical manometry, in 32.8% (n=20) of the dysphagia patients, important motor function deficits were achalasia, diffuse esophageal spasm, nutcracker esophagus, low esophageal sphincter relaxation disorder, and hypertensive low esophageal sphincter. In impedance analysis, bolus transit anomaly was determined in 95% (n=19) of these patients. In 13.1% (n=8) of the patients, ineffective esophageal motility was determined, with disordered bolus transit in 62.5%. By classical manometry method, in 45.9% (n=28) of the patients, motor function deficits that could be the etiology for dysphagia were detected. In 54.1% of the patients, however, the etiology for dysphagia could not be defined.In the analysis using Chicago classification, diagnoses that could be associated with dysphagia were established by high resolution manometry in 80.3% (n=49) of the patients, among whom the rate of bolus transit anomaly was 85.7% (n=42).According to the results of the study, it was concluded that combined high resolution manometry and bolus transit analysis with impedance system provides additional diagnostic contribution of nearly 35%.