Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals

Cisternas, Daniel; Scheerens, Charlotte; Omari, Taher; Monrroy, Hugo; Hani, Albis; Leguízamo, Ana María; Bilder, Claudio R.; Ditaranto, Andres; León, Antonio Ruiz de; Serna, Julio; Valdovinos, Miguel A.; Coello, Roberto Carlos Alvarez; Abrahão, Luiz; Remes-Troche, José María; Meixueiro, Arturo; Zavala, Miguel; Marín, Íngrid; Serra, Jordi

doi:10.1111/nmo.13088

Cited by 12 publications

(15 citation statements)

References 46 publications

(84 reference statements)

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“…The clinical significance of IEM remains unclear because most studies failed to find any correlation with symptoms 2‐6,9,19 . In the study by Jain et.…”

Section: Discussionmentioning

confidence: 99%

Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients

Zerbib

Marín

Cisternas

et al. 2020

Neurogastroenterology Motil

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Background The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance. Methods To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high‐resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients’ customary symptoms. Key Results In asymptomatic controls, the normal range of swallows with CBT was 50%‐100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions (P < .001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions ≥30% (specificity 88.2% and sensitivity of 84.6%), and ≥70% ineffective (failed + weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores. Conclusions and Inferences Based on bolus clearance assessed by HRIM, ≥30% failed contractions and ≥70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.

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“…The clinical significance of IEM remains unclear because most studies failed to find any correlation with symptoms 2‐6,9,19 . In the study by Jain et.…”

Section: Discussionmentioning

confidence: 99%

Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients

Zerbib

Marín

Cisternas

et al. 2020

Neurogastroenterology Motil

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“…bolus transit perception in patients without mechanical obstruction might be due to esophageal hypersensitivity (7) . Anxiety is a predictor of perception of esophageal bolus transit in cases of hypotensive motility (15) . Esophageal motor function alone did not explain differences in bolus perception, suggesting that different mechanisms are relevant in different individuals.…”

Section: Resultsmentioning

confidence: 99%

“…Esophageal motor function alone did not explain differences in bolus perception, suggesting that different mechanisms are relevant in different individuals. The perception of bolus transit is less common than abnormal motility (15) . In a previous investigation only 9.6% of the volunteers reported perception of esophageal bolus passage, which happened in 3.5% of the swallows (15) .…”

Section: Resultsmentioning

confidence: 99%

Altered Esophageal Motility During Perception of Bolus Transit in Healthy Volunteers

Costa

Dantas

2019

Arq. Gastroenterol.

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BACKGROUND: The perception of bolus transit through the thoracic esophagus may be caused by altered esophageal anatomy and function. OBJECTIVE: To evaluate the hypothesis that, in healthy volunteers, swallows followed by perception of esophageal bolus transit are associated with changes in esophageal motility. METHODS: Simultaneous evaluation of motility and perception of esophageal bolus transit was performed in 22 healthy volunteers. Esophageal motility was evaluated by high-resolution manometry with a 32-channel solid state catheter. Each volunteer performed, in the sitting position, 10 swallows of a 5 mL bolus of saline and 10 swallows of pieces of 1 cm3 of bread, with an interval of at least 30 seconds between swallows. After each swallow the volunteers were asked about the perception of bolus transit through the esophagus. RESULTS: Perception of bolus transit occurred in 11.7% of liquid swallows and in 48.1% of solid swallows. In liquid swallows the perception was associated with higher distal contractile integral and shorter proximal contraction length. Perception of solid bolus transit was associated with a longer distal latency, longer proximal contraction length, lower proximal contractile integral and shorter proximal contraction duration. CONCLUSION: The perception of swallowed bolus transit through the esophagus in healthy individuals is more frequent with solid than liquid swallows and is associated with changes in proximal esophageal contractions.

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“…Carlson et al found no difference in responder rate (defined as ESS < 3) when comparing patients with complete vs incomplete bolus transit after treatment. This lack of correlation between bolus perception/dysphagia and objective measurements has also been shown using other ways of sensation evaluation (like Likert scale) in healthy and symptomatic individuals . This highlights the fact that dysphagia is a complex phenomenon that goes far beyond our current methods to evaluate esophageal function.…”

Section: Discussionmentioning

confidence: 99%

Fair reliability of eckardt scores in achalasia and non‐achalasia patients: Psychometric properties of the eckardt spanish version in a multicentric study

Cisternas

Monrroy

Riquelme

et al. 2020

Neurogastroenterology Motil

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Background: Eckardt symptom score (ESS) is the most used tool for the evaluation of esophageal symptoms. Recent data suggest that it might have suboptimal reliability and validity. The aims of this study were as follows: (a) Develop and validate an international Spanish ESS version. (b) Perform psychometric ESS evaluation in patients with achalasia and non-achalasia patients. Methods: Eckardt symptom score translation was performed by Delphi process. ESS psychometric evaluation was done in two different samples of patients referred for manometry. First sample: 430 dysphagia non-achalasia patients. Second sample: 161 achalasia patients. Internal consistency was evaluated using Cronbach's α and Guttman coefficient (<0.5 = unacceptable. 0.5-0.7 = fair. >0.7 = acceptable). Key Results: Our data show that in patients without and with achalasia, ESS behaves similarly. Both show a fair reliability with Cronbach's α of 0.57 and 0.65, respectively.Based on our results, we recommend interpretation of the Spanish ESS be done with caution. The psychometric quality of the ESS could not be improved by removal of any items based on the single-factor structure of the scale and no items meeting criteria for elimination. Conclusions and Inferences:Eckardt symptom score Spanish translation was developed. ESS showed a fair reliability for the evaluation of patients with any causes of dysphagia. Our results highlight the need for development and psychometric validation of new dysphagia scoring tools. K E Y W O R D Sdysphagia, Eckardt symptom score, psychometric evaluation, reliability, validity

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Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals

Abstract: Background: Previous studies have not been able to correlate manometry findings with bolus

Cited by 12 publications

References 46 publications

Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients

Ineffective esophageal motility and bolus clearance. A study with combined high‐resolution manometry and impedance in asymptomatic controls and patients

Altered Esophageal Motility During Perception of Bolus Transit in Healthy Volunteers

Fair reliability of eckardt scores in achalasia and non‐achalasia patients: Psychometric properties of the eckardt spanish version in a multicentric study

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