Making Sense of Nonachalasia Esophageal Motor Disorders

Rogers, Benjamin D.; Gyawali, C. Prakash

doi:10.1016/j.gtc.2021.08.003

Cited by 2 publications

(1 citation statement)

References 115 publications

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“…Except for patients with achalasia esophagus and EGJOO, the reason for dysphagia in patients with major and minor motility disorders remains unclear because minor motor disorders are seen not infrequently in asymptomatic individuals. 10 Also, it is not clear why patients with supernormal contraction phase of peristalsis, ie, nutcracker esophagus and jackhammer esophagus should have dysphagia. 11 , 12 Furthermore, 30%–50% of patients referred for HRMZ study with dysphagia turn out to have a normal study and can be classified into functional dysphagia (FD) 13 , 14 ( Figure 1 ).…”

Section: Epidemiology Of Dysphagia Symptommentioning

confidence: 99%

Why so Many Patients With Dysphagia Have Normal Esophageal Function Testing

Mittal,

Zifan

2024

Gastro Hep Advances

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Section: Epidemiology Of Dysphagia Symptommentioning

confidence: 99%

Why so Many Patients With Dysphagia Have Normal Esophageal Function Testing

Mittal,

Zifan

2024

Gastro Hep Advances

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Enhancing the diagnostic yield of esophageal manometry using distension-contraction plots of peristalsis and artificial intelligence

Zifan,

Lee,

Mittal

2024

American Journal of Physiology-Gastrointestinal and Liver Physi

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Background: Our prior study reveal that the distension-contraction profiles using high-resolution manometry impedance (HRMZ) recordings can distinguish patients with dysphagia symptom but normal esophageal function testing ("functional dysphagia") from controls. Aims: To determine the diagnostic value of the recording protocol used in our prior studies (10cc swallows with subjects in the Trendelenburg position) against the standard clinical protocol (5cc swallows with subject in the supine position). We used advanced machine learning techniques and robust metrics for the classification purposes. Methods: Studies were performed in 30 healthy subjects and 30 patients with functional dysphagia. A custom-built software was used to extract the relevant distension-contraction features of esophageal peristalsis. Ensemble methods, i.e., gradient boost, support vector machines (SVM), and logit boost were used as the primary machine learning algorithms. Results: While the individual contraction features were marginally different between the two groups, the distension features of peristalsis were significantly different. The ROC curves values for the standard recording protocol, for the distension features ranged from 0.74 to 0.82; they were significantly better for the protocol used in our prior studies, ranged from 0.81-0.91. The ROC curve values using 3 machine learning algorithms were far superior for the distension than the contraction features of esophageal peristalsis, revealing value of 0.95 for the SVM algorithm. Conclusions: Current patient classification based on the contraction phase of peristalsis misses large number of patients who have abnormality in the distension phase of peristalsis. Distension contraction plots should be the standard of assessing esophageal peristalsis in clinical practice.

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Making Sense of Nonachalasia Esophageal Motor Disorders

Cited by 2 publications

References 115 publications

Why so Many Patients With Dysphagia Have Normal Esophageal Function Testing

Why so Many Patients With Dysphagia Have Normal Esophageal Function Testing

Enhancing the diagnostic yield of esophageal manometry using distension-contraction plots of peristalsis and artificial intelligence

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