Prevalence of Esophageal Motility Disorders in an Open Access Hybrid “Academic - Community Setting” Patient Population

Abstract

Introduction: High Resolution Manometry (HRM) is a valuable diagnostic tool to evaluate esophageal motility disorders. Studies have demonstrated improved diagnostic yield of esophageal motility disorders using HRM compared to conventional manometry. To date, there is minimal data regarding the prevalence of esophageal motility disorders in the general population of the United States, both in the academic and community setting. Methods: We performed a retrospective review of consecutive patients referred for HRM at a tertiary referral center from January 2016 to December 2017. Providers from various specialties referred patients for HRM testing through an open access ordering form. All studies were interpreted by two trained GI providers with expertise in esophageal disorders and reported in accordance with the Chicago classification of esophageal motility disorders, version 3.0. Demographic, clinical and manometry data were analyzed using descriptive statistics (MS Excel). Data are presented as Mean (SD) and N (%). Aim: To report the prevalence of esophageal motility disorders in patients from community and academic practice, presenting to the Digestive Diseases Institute Swallowing and Reflux Center motility lab. Results: The study included 771 consecutive patients, of which 515 (67%) were women. The mean age of the study group was 60 (15) years and the mean body mass index was 29.5 (10). Major indications for HRM study were gastroesophageal reflux disease 489 (63%), followed by dysphagia 198 (26%). Chicago 3.0 defined esophageal motility disorders were seen in 335 (44%) patients of the study population. Of these, ineffective esophageal motility (IEM) was the most common disorder 155/335 (46%), followed by achalasia 56/335 (17%) and esophagogastric junction outflow obstruction (EGJOO) 52/335 (16 %). While IEM was the major motility disorder in patients with GERD 108/489 (22%), achalasia 39/198 (20%) was more frequently seen in patients with dysphagia [See Graph]. Conclusion: In this large cohort of patients from the community and academic setting, we describe the prevalence of esophageal motility disorders. The results of our study may be helpful for planning treatment options and designing epidemiological studies for evaluation of GERD and dysphagia. Ineffective esophageal motility was the most common motility disorder seen in our study population. Further studies to evaluate the clinical significance and management of IEM may be helpful.325 Figure 1. Distribution of motility disorders.