Skip to main content
SpringerLink
Log in

Correlation of radiographic and manometric findings in patients with ineffective esophageal motility

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Ineffective esophageal motility disorder (IEM) is a new, manometrically defined, esophageal motility disorder, associated with severe gastroesophageal reflux disease (GERD), GERD-associated respiratory symptoms, delayed acid clearance, and mucosal injury. Videoesophagram is an important, inexpensive, and widely available tool in the diagnostic evaluation of patients with esophageal pathologies. The efficacy of videoesophagography has not been rigorously examined in patients with IEM. The aim of this study was to determine the diagnostic value of videoesophagography in patients with IEM. Methods: The radiographic and manometric findings of 202 consecutive patients presenting with foregut symptoms were evaluated. IEM was defined by strict manometric criteria. All other named motility disorders such as achalasia were excluded. Videoesophagography was performed according to a standard protocol. Results: Of patients in this cohort, 16% (33/202) had IEM by manometric criteria. Of IEM patients, 55% (18/33) had an abnormal videoesophagram, while in 45% (15/33) this test was read as normal. Only 11% (15/137) of patients with a normal videoesophagram were found to have IEM. Sensitivity of videoesophagram was 54.6%, specificity 72.2%, positive predictive value only 27.7%, and negative predictive value 89.1% in the diagnosis of IEM. Conclusions: These data show that videoesophagram is relatively insensitive in detecting patients with IEM and should not be considered a valid diagnostic test for this disorder. We conclude that esophageal manometry is an indispensable diagnostic modality in the workup of a patient with suspected of IEM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. SR Achem J Crittender B Kolts L Burton (1992) ArticleTitleLong-term clinical and manometric follow-up of patients with non-specific esophageal motility disorders. Am J Gastroenterol 87 825–830 Occurrence Handle1:STN:280:By2A3M3lvVE%3D Occurrence Handle1615935

    CAS  PubMed  Google Scholar 

  2. YA Aly (2000) ArticleTitleDigital radiography in the evaluation of oesophageal motility disorders. Clin Radiol 55 561–568 Occurrence Handle10.1053/crad.1999.0509 Occurrence Handle1:STN:280:DC%2BD3cvhtFartg%3D%3D Occurrence Handle10924382

    Article  CAS  PubMed  Google Scholar 

  3. RCW Bell P Hanna MR Mills D Bowrey (1999) ArticleTitlePatterns of success and failure with laparoscopic Toupet fundoplication. Surg Endosc 13 1189–94 Occurrence Handle1:STN:280:DC%2BD3c%2FmtlemsA%3D%3D Occurrence Handle10594263

    CAS  PubMed  Google Scholar 

  4. D Blom JH Peters TR DeMeester PF Crookes JA Hagen SR DeMeester C Bremner (2002) ArticleTitlePhysiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication. J Gastrointest Surg 6 22–28 Occurrence Handle10.1016/S1091-255X(01)00051-8 Occurrence Handle11986014

    Article  PubMed  Google Scholar 

  5. DO Castell (2001) ArticleTitleEsophageal manometry prior to antireflux surgery: required, preferred or even needed? Gastroenterology 121 214–216 Occurrence Handle1:STN:280:DC%2BD3MzotV2msg%3D%3D Occurrence Handle11438510

    CAS  PubMed  Google Scholar 

  6. MYM Chen DJ Ott JW Sinclair WC Wu DW Gelfand (1992) ArticleTitleGastroesophageal reflux disease:correlation of esophageal pH testing and radiographic findings. Radiology 185 483–486 Occurrence Handle1:STN:280:ByyD38bjtlA%3D Occurrence Handle1410359

    CAS  PubMed  Google Scholar 

  7. YM Chen DJ Ott EG Hewson JE Richter WC Wu DW Gelfand DO Castell (1989) ArticleTitleDiffuse esophageal spasm: radiographic and manometric correlation. Radiology 170 807–810 Occurrence Handle1:STN:280:BiaC38bjsFY%3D Occurrence Handle2916033

    CAS  PubMed  Google Scholar 

  8. PF Crookes JH Peters TR DeMeester (1995) ArticleTitlePhysiology of the anti-reflux barrier and diagnostic tests of forgut function. Semin Laparosc Surg 2 10–26

    Google Scholar 

  9. U Diener MG Patti D Molena PM Fisichella LW Way (2001) ArticleTitleEsophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg 5 260–265 Occurrence Handle10.1016/S1091-255X(01)80046-9 Occurrence Handle1:STN:280:DC%2BD3MzjtlCktg%3D%3D Occurrence Handle11360049

    Article  CAS  PubMed  Google Scholar 

  10. C Fibbe P Layer J Keller U Strate A Emmermann C Zornig (2001) ArticleTitleEsophageal motility in reflux disease before and after fundoplication: a prospective randomized clinical and manometric study. Gastroenterology 121 5–14 Occurrence Handle1:STN:280:DC%2BD3MzotV2lsw%3D%3D Occurrence Handle11438489

    CAS  PubMed  Google Scholar 

  11. YM Fouad PO Katz JG Hatlebakk DO Castell (1999) ArticleTitleIneffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms. Am J Gastroenterol 94 1464–1467

    Google Scholar 

  12. L Fuller JE Huprich J Theisen JA Hagen PF Crookes SR Demeester CG Bremner TR Demeester JH Peters (1999) ArticleTitleAbnormal esophageal body function: radiographic–manometric correlation. Am Surg 65 911–914 Occurrence Handle1:STN:280:DyaK1MvktlGmtA%3D%3D Occurrence Handle10515533

    CAS  PubMed  Google Scholar 

  13. TR Heider KE Behrns MJ Koruda NJ Shaheen TA Lucktong B Bradshaw TM Farrell (2003) ArticleTitleFundoplication improves disordered esophageal motility. J Gastrointest Surg 7 159–163 Occurrence Handle10.1016/S1091-255X(02)00145-2 Occurrence Handle12600439

    Article  PubMed  Google Scholar 

  14. SC Ho CS Chang CY Wu GH Chen (2002) ArticleTitleIneffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci 47 652–656 Occurrence Handle10.1023/A:1017992808762 Occurrence Handle11911355

    Article  PubMed  Google Scholar 

  15. PJ Kahrilas WJ Dodds WJ Hogan (1988) ArticleTitleEffect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94 73–80

    Google Scholar 

  16. WK Kauer JH Peters TR DeMeester J Heimbucher AP Ireland CG Bremner (1995) ArticleTitleA tailored approach to antireflux surgery. J Thorac Cardiovasc Surg 110 141–147 Occurrence Handle1:STN:280:ByqA3szotFU%3D Occurrence Handle7609537

    CAS  PubMed  Google Scholar 

  17. LP Leite BT Johnston J Barrett JA Castell DO Castell (1997) ArticleTitleIneffective esophageal motility (IEM): the primary finding in patients with non-specific esophageal motility disorder. Dig Dis Sci 42 1853–1858 Occurrence Handle10.1023/A:1018850824287 Occurrence Handle1:CAS:528:DyaK2sXmslOqtrg%3D Occurrence Handle9331147

    Article  CAS  PubMed  Google Scholar 

  18. RJ Lund GJ Wetcher F Raiser K Glaser G Perdikis G Gadenstatter N Katada CJ Filipi RA Hinder (1997) ArticleTitleLaparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1 301–308 Occurrence Handle10.1016/S1091-255X(97)80049-2 Occurrence Handle9834362

    Article  PubMed  Google Scholar 

  19. MG Patti M De Pinto M de Bellis M Arcerito J Tong A Wang SJ Mulvihill LW Way (1997) ArticleTitleComparison of laparoscopic total and partial fundoplication for gastroesophageal reflux. J Gastrointest Surg 1 309–315 Occurrence Handle10.1016/S1091-255X(97)80050-9 Occurrence Handle9834363

    Article  PubMed  Google Scholar 

  20. JE Richter WC Wu DN Johns JN Blackwell JL Nelson JA Castell DO Castell (1987) ArticleTitleEsophageal manometry in 95 healthy volunteers: variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32 583–592 Occurrence Handle1:STN:280:BiiC1cbltlw%3D Occurrence Handle3568945

    CAS  PubMed  Google Scholar 

  21. SAGES Committee on Standards of Practice (2001) Guideline for surgical treatment of gastroesophageal reflux disease (GERD). Society of American Gastrointestinal Endoscopic Surgeons, www.sages.org .

  22. SJ Spechler DO Castell (2001) ArticleTitleClassification of oesophageal motility abnormalities. Gut 49 145–151 Occurrence Handle10.1136/gut.49.1.145 Occurrence Handle1:STN:280:DC%2BD3MzkvFOgug%3D%3D Occurrence Handle11413123

    Article  CAS  PubMed  Google Scholar 

  23. JK Thompson RE Koehler JE Richter (1994) ArticleTitleDetection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. Am J Roentgenol 162 621–626

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA

    J. S. Shakespear

  2. Department of Surgery, Medical College of Wisconsin, Froedtert Hospital, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA

    D. Blom

  3. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

    J. E. Huprich

  4. Department of Surgery, University of Southern California, 1510 San Pablo Street, #514, Los Angeles, CA 90033, USA

    J. H. Peters

Authors
  1. J. S. Shakespear
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Blom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. E. Huprich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. H. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Blom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shakespear, J., Blom, D., Huprich, J. et al. Correlation of radiographic and manometric findings in patients with ineffective esophageal motility. Surg Endosc 18, 459–462 (2004). https://doi.org/10.1007/s00464-003-8920-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8920-4

Keywords

Search

Navigation