Hypercontractile Esophagus: Clinical Presentation, Role of Provocative Tests in High Resolution Manometry and Long Term Outcome-Results From an Asian Cohort.

BACKGROUND

Hypercontractile esophagus (HE) is rare. Esophageal high-resolution manometry (HRM) with solid test meal (STM) in Chicago Classification (CCv4.0) may improve diagnostic yield, but outcome data are lacking.

AIM: Evaluate the clinical features and long-term outcome of HE, and determine the clinical significance of hypercontractility detected only using STM.

METHODS

Single-center analysis of all patients with ≥ 2 hypercontractile swallows (HS) (distal contractile integral [DCI] > 8000 mmHg.s.cm) on HRM studies with single water swallows (SWS) and/or STM between June 2014 and December 2021. A telephone survey was conducted between January and June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores, and the Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q) to determine long-term outcomes.

RESULTS

Forty-eight patients (29 [60.4%] Female, 63.0 [13.4] years) with HS who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28 [48.3%] Female, 49 [13.4] years) with dysphagia (n = 43.1%), reflux (n = 41.4%) and chest pain (15.5%) with normal HRM findings were identified from 454 studies performed. More patients had HS with STM versus SWS (n = 41 [85.4%] vs. n = 7 [14.6%], p < 0.001). Dysphagia was significantly associated with mean DCI (B = 0.000, p = 0.035) and maximal DCI (B = 0.000, p = 0.036) during STM. 43% (n = 3/7) and 22% (n = 9/41) of patients with ≥ 2 HS using SWS and STM respectively were on medical therapy at mean (SD) clinic follow-up of 28.7 (29.2) months. At mean (SD) follow-up telephone survey of 61.3 (27.1) months from HRM, symptom scores amongst 36/48 (75%) patients and 58 controls were: IDQ (3.8 [0-4] vs. 1.0 [0-1.3], p = 0.03); Eckardt dysphagia score (0.46 [0.0-1.0] vs. 0.14 [0-0], p = 0.007); GerdQ (6.4 [6.0-6.0] vs. 7.0 [6.0-8.0], pNS) respectively.

CONCLUSIONS

STM enhanced diagnostic yield of HS and identified more patients who benefitted from medical therapy.