P0420 - What’s GERD Got to Do With DES: Comparing Characteristics of Reflux and Non-Reflux Phenotypes of Distal Esophageal Spasm

Emily S. Seltzer, DO, MS¹, Robinderpal Sandhu, MD², Mantej Sehmbhi, MBBS³, Kimberly Cavaliere, MD², Michael S.. Smith, MD, MBA³, Daniela Jodorkovsky, MD^4
1Mount Sinai West and Morningside, New York, NY; ²Mount Sinai Morningside-West, New York, NY; ³Icahn School of Medicine at Mount Sinai, New York, NY; ⁴Mount Sinai West/Morningside Hospitals, New York, NY

Introduction: Distal esophageal spasm (DES) is a rare motility disorder characterized by ≥20% premature contractions (distal latency ≤ 4.5s) and a distal contractile integral of ≥450 mmHg·s·cm on high-resolution manometry (HRM). Cardinal symptoms of DES include dysphagia and non-cardiac chest pain. Previous studies suggested a potential association between DES and gastroesophageal reflux disease (GERD) based on endoscopic findings or acid perfusion. However, the recommendation for DES management is to “optimize GERD treatment,” despite limited supporting data. This study aims to investigate symptomatic and manometric differences among DES patients with and without GERD on quantitative testing.

Methods: A retrospective cohort study was conducted using HRM and reflux testing from 2/2020-12/2022. Exclusion criteria included type III achalasia or prior foregut surgery. Participants with DES on HRM were characterized by reflux testing results. The reflux DES group (R-DES) included individuals with endoscopic evidence of GERD (Los Angeles grade C/D esophagitis or Barrett’s) or elevated acid exposure on 24–48-hour pH testing. The non-reflux group (NR-DES) consisted of patients with normal 24–48-hour reflux testing. Descriptive and univariate analyses were performed comparing R-DES to NR-DES subjects.

Results: A total of 99 eligible subjects with DES were identified, with 66 undergoing reflux testing and 2 with Barrett’s. The R-DES cohort included 32 subjects and NR-DES cohort had 36 subjects. Compared to NR-DES, R-DES subjects weighed more (mean BMI 30.33, 26.93, p = 0.012). Both groups exhibited similar usage rates of proton pump inhibitors (78.1%, 91.7%, p=0.218) and chronic opioids (10%, 5.6%, p=0.652). No significant differences between groups were observed with respect to presenting symptoms (heartburn, regurgitation, abdominal pain, globus sensation, belching, nausea/vomiting, dysphagia, or chest pain) or HRM metrics (hiatal hernia size, basal LES pressure, residual LES pressure, or bolus clearance).

Discussion: Despite the long-believed association between DES and GERD, this study demonstrates that DES patients with and without GERD do not exhibit phenotypic differences in symptom presentation or HRM metrics associated with GERD physiology. Based on this data, the role of GERD in DES has been overemphasized. To establish causation and assess the clinical significance of GERD, future studies should investigate potential differences in treatment response between DES patients with and without reflux.



Disclosures:


Emily S. Seltzer, DO, MS¹, Robinderpal Sandhu, MD², Mantej Sehmbhi, MBBS³, Kimberly Cavaliere, MD², Michael S.. Smith, MD, MBA³, Daniela Jodorkovsky, MD⁴. P0420 - What’s GERD Got to Do With DES: Comparing Characteristics of Reflux and Non-Reflux Phenotypes of Distal Esophageal Spasm, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.