Esophageal dysmotility according to Chicago classification v3.0 vs v2.0: Implications for association with reflux, bolus clearance, and allograft failure post‐lung transplantation

Tangaroonsanti, Anupong; Vela, Marcelo F.; Crowell, Michael D.; DeVault, Kenneth R.; Houghton, Lesley A.

doi:10.1111/nmo.13296

Cited by 12 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These observations support our previous findings that minor peristaltic abnormalities not classified as abnormal by CCv3.0 can associate with increased reflux exposure in respiratory patients. [14,15] In contrast, in IPF patients with normal motility, DCI strongly and inversely correlated with the proportion of reflux events reaching the proximal esophagus, a relationship not seen with total reflux exposure, likely because the inter-patient variation in DCI will be small in patients with normal motility and tLESRs appeared to be not increased. Thus, in patients with respiratory disease, such as IPF, ineffective esophageal peristaltic events, along with potentially other motor features not measured in this study, such as abnormal esophageal tone and post-reflux swallow-induced peristaltic wave (PSPW) index, may be associated with poor clearance and proximal migration of reflux events, possibly aided by factors not present in patients with GERD only, such as greater negative intra-thoracic pressure.…”

Section: Discussionmentioning

confidence: 89%

“…Following at least a 30s baseline to identify the upper esophageal sphincter (UES) and LES, ten 5 ml saline swallows were given at least 30s apart with the patient supine. [14,15] HRIM recordings were analyzed manually, blinded to pulmonary function data, using appropriate dedicated software (ManoView Analysis Software v3.01, Medtronic Inc., Shoreview, MN or Solar GI HRM, MMS, Enschede, The Netherlands). CCv3.0 algorithms were applied to make a diagnosis of normal or an esophageal motility disorder.…”

Section: Hrimmentioning

confidence: 99%

See 1 more Smart Citation

The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis

et al. 2021

View full text Add to dashboard Cite

Introduction: Gastroesophageal reflux plays a significant role in idiopathic pulmonary fibrosis (IPF).Given the morbidity and mortality associated with IPF, understanding the mechanisms responsible for reflux is essential if patients are to receive optimal treatment and management, especially given the lack of clear benefit of anti-reflux therapies. Our aim was to understand the inter-relationships between esophageal motility, lung mechanics and reflux (particularly proximal reflux -a prerequisite of aspiration), and pulmonary function in IPF patients. Methods:We prospectively recruited 35 IPF patients (aged 53-75yrs; 27 male) who underwent highresolution impedance manometry and 24-hr pH-impedance, together with pulmonary function assessment.Results: Twenty-two (63%) patients exhibited dysmotility, 16(73%) ineffective esophageal motility (IEM) and 6(27%) esophagogastric junction outflow obstruction. Patients with IEM had more severe pulmonary disease (%FVC:p=0.032) and more proximal reflux (p=0.074) than patients with normal motility. In patients with IEM, intra-thoracic pressure inversely correlated with the number of proximal events (r=-0.429;p=0.098). Surprisingly, inspiratory lower esophageal sphincter pressure (LESP) positively correlated with the percentage of reflux events reaching the proximal esophagus (r=0.583;p=0.018), whilst in patients with normal motility it inversely correlated with the bolus exposure time (r=-0.478;p=0.098) and number of proximal events (r=-0.542;p=0.056). %FVC in IEM patients inversely correlated with the percentage of reflux events reaching the proximal esophagus (r=-0.520;p=0.039) and inspiratory LESP (r=-0.477;p=0.062), and positively correlated with intrathoracic pressure (r=0.633;p=0.008). Conclusions:We have shown that pulmonary function is worse in patients with IEM which is associated with more proximal reflux events, the latter correlating with lower intra-thoracic pressures and higher LESPs.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Hrimmentioning

confidence: 99%

The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Irrespective of Chicago Classification used, only patients with esophagogastric junction outflow obstruction appeared more likely to develop allograft dysfunction than those with normal motility (P<0.05). Thus, the identification of more subtle abnormalities of hypocontractility (and therefore incomplete bolus transit and increased reflux) highlighted in Chicago classification v2.0 may have important consequences of allograft failure post-lung transplantation (19).…”

Section: Esophageal Disease After Lung Transplantationmentioning

confidence: 99%

Esophageal disease in lung transplant patients

Young¹,

Coppolino²

2021

Ann Transl Med

View full text Add to dashboard Cite

There is a very well-established and complex interplay between gastroesophageal reflux and lung disease. This is particularly true in end-stage lung disease and post-lung transplant patients. Numerous studies have shown that in patients who are undergoing pre-lung transplant evaluations for diseases such as idiopathic pulmonary fibrosis (IPF), emphysema, connective tissue disease, there is a high prevalence of gastroesophageal reflux and esophageal dysmotility. Post-lung transplant, many of the reflux issues persist or worsen, and there is some evidence to suggest that this leads to worsened long-term allograft function and bronchiolitis obliterans. Anti-reflux operations in patients with lung disease have been shown to be safe in both the pre and post-lung transplant setting and lead to improved reflux symptoms, as well as protecting against reflux induced allograft dysfunction in the post-lung transplant patients. Barrett's esophagus and esophageal malignancy are also not unheard of in these patients, and select patients may benefit from operative intervention. This review discusses the links between gastroesophageal reflux and lung transplant patients in both the pre and post-transplant setting. We also review the approach to the workup of esophageal disease in the pre-lung transplant setting as well as the surgical management of this unique group of patients.

show abstract

“…Tagaroonsanti et al used HRIM to demonstrate that esophagogastric junction outflow obstruction (EGJOO), incomplete bolus clearance (IBC), and proximal reflux were risk factors for CLAD (98). They also reported that hypo-contractility on HRIM (defined by the Chicago classification v2.0) was associated with IBC and abnormal number of reflux events, both previously implicated in CLAD (99). Outflow obstruction in conjunction with abnormal bolus clearance perpetuate esophageal stasis and delayed esophageal acid clearance, therefore increasing the risk of aspiration.…”

Section: Motility Considerations In Lung Transplantmentioning

confidence: 99%

Gastrointestinal Dysmotility and the Implications for Respiratory Disease

Ambartsumyan

Nurko

Rosen

2019

Curr Treat Options Peds

View full text Add to dashboard Cite

Purpose of the review: Gastroesophageal reflux disease (GERD) is frequently implicated as a cause for respiratory disease. However, there is growing evidence that upper gastrointestinal dysmotility may play a significantly larger role in genesis of respiratory symptoms and development of underlying pulmonary pathology. This paper will discuss the differential diagnosis for esophageal and gastric dysmotility in aerodigestive patients and will review the key diagnostic and therapeutic interventions for this dysmotility.Recent findings: Previous studies have shown an association between GERD and pulmonary pathology in children with aerodigestive disorders. Recent publications have demonstrated the presence of esophageal and gastric dysfunction, using fluoroscopic and nuclear medicine studies, in aerodigestive patients who commonly present to pulmonary and otolaryngology clinics. Highresolution impedance manometry (HRIM) has revolutionized our understanding of esophageal dysmotility and its role in pathogenesis of aspiration and esophageal dysfunction and subsequent respiratory compromise.Summary: Esophageal and gastric dysmotility have a profound effect on development of respiratory symptoms and pulmonary sequalae in aerodigestive patients. However, our understanding of the pathophysiology is in its infancy. Prospective studies in are needed to address key clinical questions such as: What degree of dysmotility initiates respiratory compromise? What diagnostic tests and therapeutic options best predict aerodigestive outcomes?

show abstract

Esophageal dysmotility according to Chicago classification v3.0 vs v2.0: Implications for association with reflux, bolus clearance, and allograft failure post‐lung transplantation

Cited by 12 publications

References 22 publications

The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis

The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis

Esophageal disease in lung transplant patients

Gastrointestinal Dysmotility and the Implications for Respiratory Disease

Contact Info

Product

Resources

About