Esophageal pressure topography offers diagnostic advantages

Last Updated: 2015-06-15

By David Douglas

NEW YORK (Reuters Health) - Compared to interpretation of conventional line tracings (CLT), scrutiny of esophageal pressure topography (EPT) provides more accurate esophageal motility diagnoses, according to researchers.

In a June 2 online paper in the American Journal of Gastroenterology, Dr. Dustin A. Carlson of Northwestern University Feinberg School of Medicine, Chicago, and colleagues note that although EPT can provide enhanced characterization of esophageal peristaltic and sphincter function, costs are greater and advantages have been unclear.

To investigate further, the researchers enrolled six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows).

In two sessions, separated in time by at least two weeks, each rater analyzed a set of the same previously completed 40 patient high-resolution esophageal manometry studies. These were displayed in EPT and CLT formats. The analysis order (EPT or CLT first) was random.

For attendings, inter-rater agreement was deemed good for EPT and moderate for CLT. Corresponding findings in fellows were moderate and poor to fair. Thus overall, inter-rater agreement was better with EPT.

Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT. The odds of incorrect identification of a major motility disorder were 3.4 times higher with CLT than with EPT.

"Within the limits of our study," say the investigators "our findings suggest that interpretation of manometry studies using EPT format may be considered the preferred method for evaluating esophageal motility."

This is particularly so "when directing utilization of invasive diagnostic or therapeutic procedures."

In fact, Dr. Carlson told Reuters Health by email, "By providing more reliable and accurate interpretation, as supported by our study, use of EPT over CLT allows for improved diagnosis of esophageal motility disorders, which subsequently may provide more consistent and appropriate application of management strategies for patients."

This research was supported by the Public Health service. Five coauthors reported relationships with Given Imaging/Covidien, which markets manometry software.

SOURCE: http://bit.ly/1G8pvkq

Am J Gastroenterol 2015.