Clinical and Objective Findings in Patients with Abnormal Peristaltic Breaks on High Resolution Esophageal Manometry

Purpose: The goal of this study was to assess the clinical and objective findings in patients with abnormal peristaltic breaks on high resolution esophageal manometry (HRM). Methods: The manometry records and charts of all patients undergoing HRM between June 2012 and May 2013 were reviewed. Patients with esophageal aperistalsis were excluded. Abnormal peristaltic breaks were defined as short (2-5 cm in length in >30% of swallows) or long (>5cm in >20% of swallows) using the 20 mmHg isobaric contour. Clinical symptoms, EGD, videoesophagram (VE), and esophageal function were compared in patients with and without abnormal peristaltic breaks. Results: There were 218 patients who underwent HRM (96 males and 122 females) with a median age of 58 years (16-91). Evaluation was for GERD symptoms in 196 (90%) and a primary symptom of dysphagia in 22 (10%). Abnormal peristaltic breaks were present in 40 patients (18%). Long breaks occurred in 60% and short breaks occurred in 40%. Patients with abnormal peristaltic breaks were older (65 vs 56 years, p<0.0001) and more likely to have a primary symptom of dysphagia (20% vs 8%, p=0.03). There were fewer peristaltic contractions (7.5 vs 10, p=0.003), more simultaneous contractions (0.5 vs 0, p=0.001) and a lower mean wave amplitude (52.6 vs 84.6mmHg, p<0.0001) in patients with abnormal peristaltic breaks. Esophagitis was more common in patients with abnormal peristaltic breaks (29% vs 10%, p=0.01), and they were more likely to have incomplete bolus transport with all liquid (41% vs 23%, p=0.04) and solid (32% vs 15%, p=0.03) swallows. The location of the break was proximal in 36 and distal in 4 patients. Esophagitis was more common in patients with distal breaks (100% vs 19%, p=0.0004). The frequency of a primary symptom of dysphagia was similar between patients with proximal and distal breaks (22% vs 25%, p=1). Conclusion: In patients with abnormal peristaltic breaks abnormalities on HRM, endoscopy and VE are commonly present. Breaks are more common in patients with a primary symptom of dysphagia, but the importance of the associated abnormalities in esophageal function as the cause of dysphagia needs further evaluation.