Impact of symptom burden and health‐related quality of life (HRQOL) on esophageal motor diagnoses

• Published in: Neurogastroenterology and motility Vol. 29; no. 4; pp. np - n/a
• Main Authors: Reddy, C. A., Patel, A., Gyawali, C. P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2017
• Subjects: Chicago Classification; Cost of Illness; dysphagia; Esophageal Motility Disorders - diagnosis; Esophageal Motility Disorders - physiopathology; Esophageal Motility Disorders - psychology; Female; Health Surveys - methods; high‐resolution manometry; Humans; Male; Manometry - methods; Middle Aged; Quality of Life - psychology; symptom burden; Chicago Classification; dysphagia; symptom burden; high-resolution manometry
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.12970

Background High‐resolution manometry (HRM) categorizes esophageal motor processes into specific Chicago Classification (CC) diagnoses, but the clinical impact of these motor diagnoses on symptom burden remain unclear. Methods Two hundred and eleven subjects (56.8±1.0 years, 66.8% F) completed symptom questionnaires (GERDQ, Mayo dysphagia questionnaire [MDQ], visceral sensitivity index, short‐form 36, dominant symptom index, and global symptom severity [GSS] on a 100‐mm visual analog scale) prior to HRM. Subjects were stratified according to CC v3.0 and by dominant presenting symptom; contraction wave abnormalities (CWA) were evaluated within “normal” CC. Symptom burden, impact of diagnoses, and HRQOL were compared within and between cohorts. Key Results Major motor disorders had highest global symptom burden (P=.02), “normal” had lowest (P<.01). Dysphagia (MDQ) was highest with esophageal outflow obstruction (P=.02), but reflux symptoms (GERDQ) were similar in CC cohorts (P=ns). Absent contractility aligned best with minor motor disorders. Consequently, pathophysiologic categorization into outflow obstruction, hypermotility, and hypomotility resulted in a gradient of decreasing dysphagia and increasing reflux burden (P<.05 across groups); GSS (P=.05) was highest with hypomotility and lowest with “normal” (P=.002). Within the “normal” cohort, 33.3% had CWA; this subgroup had symptom burden similar to hypermotility. Upon stratification by symptoms, symptom burden (GSS, MDQ, HRQOL) was most profound with dysphagia. Conclusions and Inferences Chicago Classification v3.0 diagnoses identify subjects with highest symptom burden, but pathophysiologic categorization may allow better stratification by symptom type and burden. Contraction wave abnormalities are clinically relevant and different from true normal motor function. Transit symptoms have highest yield for a motor diagnosis. The interrelationship between esophageal symptom characteristics, symptom burden, and motor diagnoses (Chicago Classification v 3.0) were further studied by obtaining validated self‐report questionnaires in 211 patients undergoing esophageal high‐resolution manometry (HRM). Chicago Classification diagnoses (outflow obstruction, major disorders) were associated with the highest symptom burden. Symptom characteristics were best characterized by pathophysiologic categorization of motor disorders into outflow obstruction, hypermotility disorders, and hypomotility disorders. Contraction wave abnormalities in patients without a motor disorder (according to Chicago Classification) had distinct symptom characteristics and symptom burden that aligned best with hypermotility disorders.