P0419 - Defining a Clinical Phenotype: A Retrospective Comparative Analysis of Patients With Distal Esophageal Spasm (DES) and Normal High-Resolution Esophageal Manometry

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 and poorly understood disorder defined as at least 20% premature contractions on High Resolution esophageal Manometry (HRM) per Chicago Classification (CC). DES has a heterogeneous presentation and can be incidentally found on HRM. CC v4.0 stipulates that DES is clinically relevant only if patients present with dysphagia or chest pain. The association between DES and gastroesophageal reflux disease (GERD) is not fully established. This study aims to define a clinical phenotype of DES by examining clinical differences between DES and normal findings on HRM.

Methods: A retrospective cohort study was conducted comparing subjects with DES, defined by CC v4.0, to subjects without any CC v3.0 or 4.0 motility disorder on HRM from 2/2020-12/2022. Patients with type III achalasia or prior foregut surgery were excluded. A diagnosis of GERD was defined as having Los Angeles Grade C/D esophagitis or Barrett’s on endoscopy, and/or a positive 24–48-hour reflux testing. To compare characteristics of DES to normal HRM subjects, descriptive and univariate analysis was used.

Results: A total of 99 DES and 66 normal HRM subjects met inclusion criteria (Table 1). DES patients were older (57.8 yrs, 52.2 yrs, p=0.023) and had a higher mean BMI (29.5, 26.3, p=0.001). Opiate use was similar between groups (8.6%, 6.1%, p=0.763). Proton Pump Inhibitors (PPIs) were commonly used in both groups (82%, 77%, p=0.49), though more patients with DES underwent reflux testing on PPIs (p < 0.001). HRMs Among DES subjects, 75% underwent HRM as a prerequisite for GERD testing, and 14% had HRM to investigate dysphagia or chest pain. The presence of objectively diagnosed GERD did not differ among groups (47%, 56%, p=0.45). Normal HRM subjects more frequently had a positive symptom associated probability (42%, 21%, p=0.043). DES patients were not more likely to have hiatal hernias based on HRM, but when present, hernias were larger in size (2.5 cm, 1.8 cm, p=0.013).

Discussion: A clinical phenotype for DES, distinct from that of patients with normal HRM, could not be identified. DES often is found incidentally in patients undergoing HRM for pre-GERD testing, though DES patients do not have a higher prevalence of GERD. The lack of a clear clinical phenotype validates CC v4.0 recommendations to consider an HRM DES diagnosis only in the context of clinical presentation. Prospective studies should be performed to elucidate the pathophysiology and treatment targets for DES patients.



Disclosures:


Emily S. Seltzer, DO, MS¹, Robinderpal Sandhu, MD², Mantej Sehmbhi, MBBS³, Kimberly Cavaliere, MD², Michael S.. Smith, MD, MBA³, Daniela Jodorkovsky, MD⁴. P0419 - Defining a Clinical Phenotype: A Retrospective Comparative Analysis of Patients With Distal Esophageal Spasm (DES) and Normal High-Resolution Esophageal Manometry, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.