More comprehensive testing needed to characterize esophageal dysphagia (GI & Hepatology News)

The current approach to esophageal function testing is deemed insufficient for accurately characterizing esophageal motility disorders, particularly in patients with esophageal dysphagia. This inadequacy is highlighted in a report by Ravinder K. Mittal, MD, and Ali Zifan, PhD, from the University of California San Diego, published in Gastro Hep Advances.

Key points from the report include:

1. Many patients with esophageal dysphagia exhibit abnormalities undetectable with routine tests. This is especially true for patients with supernormal contraction during peristalsis, such as those with nutcracker esophagus. Additionally, up to half of dysphagia patients show normal findings on high-resolution manometry impedance (HRMZ), often leading to a broad diagnosis of functional dysphagia.
2. The current classification of esophageal motility disorders, based on the contraction phase of peristalsis, fails to fully explain the reason for dysphagia in many patients. The report suggests that the etiology of many cases remains unknown.
3. The researchers propose a more comprehensive approach to esophageal function testing. They emphasize the need to focus on esophageal distension, as relaxation is required to accommodate a bolus before contraction can effectively move it down the esophagus.
4. The study delves into the physiology of esophageal peristalsis and examines data concerning luminal cross-section measurements, esophageal distension during peristalsis, bolus flow, and distension contraction patterns in normal patients versus those with various dysphagia types.
5. Two key findings are highlighted: In patients with functional dysphagia, EGJOO, and HAEC, the bolus must travel through a narrow esophageal lumen. In patients with nonobstructive dysphagia and type 3 achalasia, the bolus moves against distal luminal occlusion.
6. The investigators advocate integrating representations of distension and contraction with objective assessments of flow timing and distensibility to complement the current classification of esophageal motility disorders.
7. The review was supported by the National Institutes of Health, and the investigators have copyright/patent protection for the computer software used to evaluate the distension contraction plots.