Automated impedance‐manometry analysis detects esophageal motor dysfunction in patients who have non‐obstructive dysphagia with normal manometry

Nguyen, Nam Q.; Holloway, Richard H.; Smout, A. J. P. M.; Omari, Taher

doi:10.1111/nmo.12040

Cited by 62 publications

(88 citation statements)

References 26 publications

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“…Data was then uploaded and analyzed using purposed designed software (AIMplot copyright T Omari, MATLAB version 2012a, the MathWorks Inc, Natick, MA, USA). As previously reported (Myers, 2012;Loots, 2013;Nguyen, 2013;Chen 2013;Rohof 2013), seven pressure-flow variables were derived from the automated analyses: (i) pressure at nadir impedance (PNadImp, mmHg), (ii) peak pressure (PeakP, mmHg), (iii) median intrabolus pressure (IBP, mmHg), (iv) time interval between nadir esophageal impedance and peak esophageal pressure (TNadImp-PP, sec), (v) IBP slope (IBP slope, mmHg s -1 ), (vi) the impedance ratio (NadImp/ImpPeakP Ratio) and (vii) Pressure Flow Index (PFI). The impedance ratio has been identified as a potential marker of incomplete bolus transit (Chen 2013;Rohof 2013).…”

Section: Esophageal Pressure-flow Analysissupporting

confidence: 78%

“…The impedance ratio has been identified as a potential marker of incomplete bolus transit (Chen 2013;Rohof 2013). The pressure flow index (PFI) is based on an empirical formula, which was designed to amplify differences in key AIM analysis metrics seen in relation to symptoms of dysphagia (Myers 2012;Loots, 2013;Nguyen, 2013;Chen, 2013). The PFI has been shown to be higher in circumstances of pressure-flow abnormality.…”

Section: Esophageal Pressure-flow Analysismentioning

confidence: 99%

“…Firstly, excessive flow resistance during bolus propulsion and secondly, extreme degrees of bolus retention when bolus transport is incomplete (Chen et al, 2013;Loots, 2013;Myers, 2012;Nguyen, 2013, Rommel 2014. Additionally, PFA metrics have been found to correlate with symptom intensity (Chet al, 2013, Omari UEG Journal 2013, Rommel et al, NMO 2014.…”

Section: Introductionmentioning

confidence: 99%

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Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

Singendonk

Kritas

Cock

et al. 2015

The Journal of Pediatrics

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Background:The Chicago Classification allows disordered esophageal motor dysfunction to be characterized into four main categories based on esophageal pressure topography (EPT) metrics. As an adjunct to EPT, pressure flow analysis relates impedance-detected bolus movement to pressure-detected bolus propulsion. The aim of this study was to perform pressure-flow analysis in a cohort of Chicago Classified pediatric patients. We hypothesized that patients within the different Chicago Classification categories would exhibit a different pressure-flow signature. Methods:Combined high-resolution impedance-and solid state pressure recordings were performed in 76 pediatric patients referred for diagnostic manometric investigation (32M; 9.1 ± 0.7 years) and 25 healthy adult controls (7M; 36.1 ± 2.2 years) using the Solar GI acquisition system (MMS, The Netherlands). Standardized saline and viscous boluses were tested. EPT metrics were calculated and an age-adjusted Chicago-Classification determined for each patient using MMS analysis software (version 8.23). Pressure-flow analysis of swallows was performed using purpose designed MATLAB-based software (AIMplot, T. Omari) which calculated the pressure-flow index (PFI), a composite measure of bolus pressurization relative to flow and the impedance ratio (IR) a measure of the extent of bolus clearance failure.Results: Based on EPT metrics, patients were mostly classified as Normal (38, 50%) or with a Category 4 disorder, usually weak peristalsis (28, 31.5%). Three (3.9%) had a Category 3 disorder, five (6.6%) had a Category 2 disorder (EGJ outflow obstruction) and two (2.6%) a

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Section: Esophageal Pressure-flow Analysissupporting

confidence: 78%

Section: Esophageal Pressure-flow Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

Singendonk

Kritas

Cock

et al. 2015

The Journal of Pediatrics

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“…5,6 Most recently, AIM analysis metrics have been shown to differentiate non-obstructive dysphagia patients with normal manometry from controls, underlining the potential of AIM analysis to shed new light on currently incompletely understood clinical issues. 7 AIM analysis is relatively simple to perform with the aid of software (called AIMplot) which generates objective metrics describing flow and pressure in the esophagus and at the level of the esophagogastric junction (EGJ). 8,9 However, to be applicable for clinical or research purposes, a high level of reproducibility is required.…”

Section: Introductionmentioning

confidence: 99%

Inter‐ and intra‐rater reproducibility of automated and integrated pressure‐flow analysis of esophageal pressure‐impedance recordings

Rohof

Myers

Estremera

et al. 2013

Neurogastroenterology Motil

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Background Automated impedance manometry pressure‐flow analysis (AIM analysis) determines pressure measurements relative to bolus flow and has to date shown subtle variations in esophageal motility in relation to dysphagia. In this study, we assessed intra‐ and inter‐rater reproducibility of AIM metrics derived using purpose designed software. Methods Fifty patients referred for evaluation of gastro‐esophageal reflux symptoms (33 men, age 52 ± 1.9 years) underwent combined high‐resolution impedance manometry and completed a dysphagia questionnaire. From 10 liquid and 10 viscous swallows, a subset of four swallows (two saline and two viscous) was systematically selected from each patient for manual and AIMplot analysis, which was performed twice by five observers (two experts, three non‐experts). Intra‐ and inter‐rater agreement were determined using intraclass correlation coefficients. Key Results AIMplot‐based analysis showed high intra‐rater and inter‐rater reproducibility for all metrics (mean ICCs of 0.95 and 0.94, respectively). Reproducibility of metrics derived for liquid and viscous did not differ (ICCs of 0.96 and 0.91 for liquid and viscous, respectively). In addition, metrics derived by experts had an equivalent level of reproducibility compared to non‐experts (ICCs of 0.96 and 0.94, respectively). Variables that could be derived with commercial software (ManoView™) correlated highly with variables from AIMplot‐based analysis, such as 4‐s integrated relaxation pressure (r = 0.85) and the 20‐mmHg isobaric contour defect (r = 0.92). Conclusions & Inferences Esophageal AIM analysis is highly reproducible, independent of an observer's level of experience in esophageal motility. Therefore, AIM analysis produces data that are reliable for clinical and research purposes.

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“…While the contractile wave helps to identify major motility disturbances, it may not account for other changes occurring within the esophageal wall that may be contributing to dysphagia. As shown by Nguyen et al in 42 patients with non-obstructive dysphagia, IBP and IBP slope were significantly higher in non-obstructive dysphagia patients than in healthy controls regardless of the presence of non-specific motility patterns [14]. In another study by Kou et al, the importance of IBP was highlighted in a computational model of esophageal transport [15].…”

Section: Discussionmentioning

confidence: 81%

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

Colizzo

Clayton

Kumar

et al. 2018

Gastrointestinal Disorders

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Eosinophilic esophagitis is characterized by dysphagia with esophageal eosinophilia. We sought to determine if intrabolus pressure measurements on high-resolution manometry had any correlation with dysphagia improvement following standard therapy for patients with fibrostenotic eosinophilic esophagitis. Consecutive patients were prospectively enrolled at our swallowing center. Dysphagia scores, esophageal eosinophil counts, endoscopic reference scores, and intrabolus pressure measurements were compared at baseline and following therapy with 8 weeks of a proton-pump inhibitor and serial bougie dilation to a luminal diameter of 17 mm. Five patients were included in the study. The median age was 38 years. The average endoscopic reference score improved from 5.0 to 2.4 (p = 0.007). The mean esophageal diameter improved from 10.8 mm to 17.2 mm (p = 0.001). Dysphagia severity scores improved from a mean value of 34.2 to 10.8 (p = 0.004). Mucosal eosinophilia had no correlation with dysphagia severity. Mean intrabolus pressure improved from 21.8 mmHg to 11 mmHg (p = 0.001). There was strong correlation between a decrease in intrabolus pressure and improvement in dysphagia severity; however, this was not significant (p = 0.108). Intrabolus pressure has strong correlation with dysphagia severity following therapy for fibrostenotic eosinophilic esophagitis. Bougie dilation provides improvement in dysphagia despite persistent mucosal eosinophilia.

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Automated impedance‐manometry analysis detects esophageal motor dysfunction in patients who have non‐obstructive dysphagia with normal manometry

Abstract: Compared with conventional pressure-impedance assessment, integrated analysis is more sensitive in detecting subtle abnormalities in esophageal function in patients with NOD and normal manometry.

Cited by 62 publications

References 26 publications

Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

Inter‐ and intra‐rater reproducibility of automated and integrated pressure‐flow analysis of esophageal pressure‐impedance recordings

Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study

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