Case Control Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2017; 23(44): 7840-7848
Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7840
Transmitted cardiovascular pulsations on high resolution esophageal impedance manometry, and their significance in dysphagia
Naueen A Chaudhry, Kamran Zahid, Sara Keihanian, Yunfeng Dai, Qing Zhang
Naueen A Chaudhry, Sara Keihanian, Qing Zhang, Department of Medicine, Division of Gastroenterology, University of Florida, Gainesville, FL 32610, United States
Kamran Zahid, Department of Medicine, Division of Hospital Medicine, University of Florida, Gainesville, FL 32610, United States
Yunfeng Dai, Department of Biostatistics, University of Florida, Gainesville, FL 32610, United States
Author contributions: Chaudhry NA was responsible for study planning and design, collecting and compiling, and also did preliminary statistical analysis. She also complied the manuscript, tables and images; Zahid K assisted in data collection, and manuscript compilation; Keihanian S provided feedback during manuscript compilation and also was part of the final approval of the manuscript; Dai Y was responsible for the final data analysis and review; Zhang Q was responsible for study planning and design, review of analytical process, feedback during manuscript compilation, and approval of the final manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the University of Florida.
Informed consent statement: The informed consent was waived by the IRB due to the retrospective nature of the study.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Statistical code and anonymized data set available from the corresponding author at naueen.chaudhry@medicine.ufl.edu. The stipulation for informed consent was waived by IRB due to the retrospective design of the study. No other data besides the one included in the manuscript are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naueen A Chaudhry, Post-Doctoral Fellow, University of Florida, Gainesville, FL 32610, United States. naueen.chaudhry@medicine.ufl.edu
Telephone: +1-609-7513330 Fax: +1-352-6279002
Received: May 12, 2017
Peer-review started: May 16, 2017
First decision: July 27, 2017
Revised: August 8, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: November 28, 2017
Processing time: 198 Days and 23.5 Hours
Abstract
AIM

To investigate the behavior of pulsatile pressure zones (PPZ’s) as noted on high resolution esophageal impedance manometry (HREIM), and determine their association with dysphagia.

METHODS

Retrospective, single center case control design screening HREIM studies for cases (dysphagia) and controls (no dysphagia). Thoracic radiology studies were reviewed further in cases for (thoracic cardiovascular) thoracic cardiovascular (TCV) structures in esophageal proximity to compare with HREIM findings. Manometric data was collected for number, location, axial length, PPZ pressure and esophageal clearance function (impedance).

RESULTS

Among 317 screened patients, 56% cases and 64% controls had PPZ’s. Fifty cases had an available thoracic radiology comparison. The distribution of PPZ’s in these 50 cases and 59 controls was similar (average 1.4 PPZ/patient). Controls (mean 31.2 ± SD 12 years) were a significantly younger population than cases (mean 67.3 ± SD 14.9 years) with P < 0.0001. The upright posture PPZ pressure was higher in controls (15.7 ± 10.0 mmHg) than cases (10.8 ± 9.7 mmHg). Although statistically significant (P = 0.005), it was a weak predictor using logistic regression and ROC model (AUC = 0.65). Three dysphagia patients had partial compression from external TCV on radiology (1 aberrant subclavian artery, 2 dilated left atrium). The posture (supine vs upright) with more prominent PPZ’s impaired bolus clearance in 9 additional cases by > 20%.

CONCLUSION

Transmitted TCV pulsations observed in HREIM bear no significant impact on swallowing. However, in older adults with dysphagia, evidence of impaired bolus clearance on impedance should be evaluated for external TCV compression. These associations have never been explored previously in literature, and are novel.

Keywords: High resolution esophageal manometry, Dysphagia, Dysphagia lusoria, Dysphagia cardia, Esophageal motility, Thoracic cardiovascular structures, Esophageal disorders

Core tip: Transmitted pulsations from thoracic cardiovascular structures are frequently observed on HREIM, and usually bear no significant impact on swallowing. However, in older adults with dysphagia, evidence of impaired bolus clearance on impedance should be further reviewed using clinical data and functional esophageal swallow studies in order to assess the possibility of external compression from cardiovascular structures.