TY - JOUR
T1 - Esophageal Hypervigilance and Visceral Anxiety Are Contributors to Symptom Severity among Patients Evaluated with High-Resolution Esophageal Manometry
AU - Carlson, Dustin A.
AU - Gyawali, C. Prakash
AU - Roman, Sabine
AU - Vela, Marcelo
AU - Taft, Tiffany H.
AU - Crowell, Michael D.
AU - Ravi, Karthik
AU - Triggs, Joseph R.
AU - Quader, Farhan
AU - Prescott, Jacqueline
AU - Lin, Frederick T.J.
AU - Mion, Francois
AU - Biasutto, Dario
AU - Keefer, Laurie
AU - Kahrilas, Peter J.
AU - Pandolfino, John E.
N1 - Funding Information:
Specific author contributions: D.A.C. contributed to study oversight, study concept and design, data analysis, data interpretation, drafting of the manuscript, and approval of the final version. C.P.G., S.R., and M.V. contributed to study concept and design, data analysis, editing the manuscript critically, and approval of the final version. T.T. and F.T.L. contributed to data analysis, editing the manuscript critically, and approval of the final version. M.C., K.R., J.R.T., F.P., J.P., and D.B. contributed to data analysis and approval of the final version. L.K. and F.M. contributed to editing the manuscript critically and approval of the final version. P.J.K. contributed to study concept and design, editing the manuscript critically, and approval of the final version. J.E.P. contributed to study concept and design, obtaining funding, editing the manuscript critically, and approval of the final version. Financial support: This work was supported by R01 DK079902 (J.E.P.) and P01 DK117824 (J.E.P., T.H.T.) from the Public Health service. Potential competing interests: D.A.C.: Medtronic (speaking, consulting). C.P.G.: Medtronic, Diversatek (speaking, consulting); Torax, Ironwood, Quintiles (consulting). S.R.: Medtronic (consulting), Diversatek Healthcare (consulting, research support), Crospon (research support), Biocodex (travel grant). M.V.: Medtronic (consulting), Diversatek (research support). T.T.: Abbvie (speaking), Janssen (speaking). Francois Mion: Laborie (speaking), Medtronic (speaking). L.K.: Pfizer (consultant; unrestricted research funding); Abbvie (unrestricted research funding), metaME connect (scientific advisor); Rome Foundation Board Member. P.J.K.: Ironwood (consulting). John E. Pandolfino: Crospon, Inc (stock options), Given Imaging (consultant, grant, speaking), Sandhill Scientific (consulting, speaking), Takeda (speaking), Astra Zeneca (speaking), Medtronic (speaking, consulting), Torax (speaking, consulting), Ironwood (consulting), Impleo (grant). F.T.J.L., M.C., K.R., J.R.T., F.Q., J.P., and D.B.: none to report.
Publisher Copyright:
© 2020 Wolters Kluwer Health. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - OBJECTIVES:Symptoms are inconsistently associated with esophageal motor findings on high-resolution manometry (HRM). We aimed to evaluate predictors of dysphagia severity, including esophageal hypervigilance and visceral anxiety, among patients evaluated with HRM.METHODS:Adult patients undergoing HRM at 4 academic medical centers (United States and France) were prospectively evaluated. HRM was completed and analyzed per the Chicago Classification v3.0. Validated symptom scores, including the Brief Esophageal Dysphagia Questionnaire and Esophageal Hypervigilance and Anxiety Scale, were completed at the time of HRM.RESULTS:Two hundred thirty-six patients, aged 18-85 (mean 53) years, 65% female, were included. Approximately 59 (25%) patients had a major motor disorder on HRM: 19 achalasia, 24 esophagogastric junction outflow obstruction, 12 absent contractility, and 4 jackhammer. Approximately 177 (75%) patients did not have a major motor disorder: 71 ineffective esophageal motility and 106 normal motility. Having a major motor disorder was a significant predictor of dysphagia severity (R2adj = 0.049, P < 0.001), but the Esophageal Hypervigilance and Anxiety Scale score carried a predictive relationship of Brief Esophageal Dysphagia Questionnaire that was 2-fold higher than having a major motor disorder: R2adj = 0.118 (P < 0.001). This finding remained when evaluated by the major motor disorder group. HRM metrics were nonsignificant.DISCUSSION:In a prospective, international multicenter study, we found that esophageal hypervigilance and visceral anxiety were the strongest predictors of dysphagia severity among patients evaluated with HRM. Thus, an assessment of esophageal hypervigilance and visceral anxiety is important to incorporate when evaluating symptom severity in clinical practice and research studies.
AB - OBJECTIVES:Symptoms are inconsistently associated with esophageal motor findings on high-resolution manometry (HRM). We aimed to evaluate predictors of dysphagia severity, including esophageal hypervigilance and visceral anxiety, among patients evaluated with HRM.METHODS:Adult patients undergoing HRM at 4 academic medical centers (United States and France) were prospectively evaluated. HRM was completed and analyzed per the Chicago Classification v3.0. Validated symptom scores, including the Brief Esophageal Dysphagia Questionnaire and Esophageal Hypervigilance and Anxiety Scale, were completed at the time of HRM.RESULTS:Two hundred thirty-six patients, aged 18-85 (mean 53) years, 65% female, were included. Approximately 59 (25%) patients had a major motor disorder on HRM: 19 achalasia, 24 esophagogastric junction outflow obstruction, 12 absent contractility, and 4 jackhammer. Approximately 177 (75%) patients did not have a major motor disorder: 71 ineffective esophageal motility and 106 normal motility. Having a major motor disorder was a significant predictor of dysphagia severity (R2adj = 0.049, P < 0.001), but the Esophageal Hypervigilance and Anxiety Scale score carried a predictive relationship of Brief Esophageal Dysphagia Questionnaire that was 2-fold higher than having a major motor disorder: R2adj = 0.118 (P < 0.001). This finding remained when evaluated by the major motor disorder group. HRM metrics were nonsignificant.DISCUSSION:In a prospective, international multicenter study, we found that esophageal hypervigilance and visceral anxiety were the strongest predictors of dysphagia severity among patients evaluated with HRM. Thus, an assessment of esophageal hypervigilance and visceral anxiety is important to incorporate when evaluating symptom severity in clinical practice and research studies.
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U2 - 10.14309/ajg.0000000000000536
DO - 10.14309/ajg.0000000000000536
M3 - Article
C2 - 31990697
AN - SCOPUS:85081944512
VL - 115
SP - 367
EP - 375
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
SN - 0002-9270
IS - 3
ER -