Changes in high-resolution manometric diagnosis over time: implications for clinical decision-making.

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Accuracy

Background:

• High-resolution esophageal manometry (HRM) is the standard for assessing esophageal motility.
• The long-term stability of HRM diagnoses and their clinical implications remain poorly understood.

Purpose of the Study:

• To evaluate the stability of HRM diagnoses over time in patients with esophageal symptoms.
• To assess changes in diagnoses and their potential impact on patient management.

Main Methods:

• Retrospective review of medical records, questionnaires, and HRM tracings.
• Application of the Chicago classification for diagnosis.
• Analysis of diagnostic changes in patients undergoing repeat HRM studies.

Main Results:

• Significant diagnostic shifts were observed across various conditions, including normal motility, esophago-gastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and ineffective esophageal motility (IEM).
• A substantial percentage of patients initially diagnosed with EGJOO, DES, or IEM experienced diagnostic changes upon repeat testing.
• Achalasia was the only diagnosis that remained stable in the single patient evaluated.

Conclusions:

• The fluidity of HRM diagnoses over time challenges their validity at any given point.
• The observed diagnostic instability raises questions about the necessity and timing of therapeutic interventions based on HRM findings.