Clinical Profile and High-Resolution Esophageal Manometry Findings in Patients Presenting with Non-Obstructive Dysphagia: A Single Center Study

Rial Juben De Leon, MD; Rona Marie Lawenko, MD; Esperanza Gracie Santi, MD
De La Salle University Medical Center

Significance: Currently, there is only one local study on manometric patterns in patients who underwent esophageal manometry over six years, highlighting the high prevalence of weak peristaltic disorders and the need for further research on their pathophysiology and management. This study aimed to provide prevalence data and manometric patterns to raise awareness of these underrecognized disorders and enable more tailored therapies. Additional research from other regions could help establish pooled prevalence data. Notably, only three centers in the country, including our institution, have this technology.

Methodology: This was a descriptive retrospective study. All patients referred for HREM at the De La Salle University Medical Centre from December 2022 to December 2024 were included in the study. Descriptive statistics of the patients’ demographic data (age, sex, BMI) were calculated. The frequency distributions of patients’ symptoms were calculated along with the abnormal and normal esophageal manometry test. The mean and standard deviation for the various groups were also determined.

Results: A total of 68 patients underwent HREM, with demographic and clinical data collected. Esophageal motility was assessed using the Chicago Classification v4.0, and bolus transit, lower esophageal sphincter (LES) function, and pressurization patterns were analyzed. The mean age of patients was 45 ± 15.86 years, with a female predominance (63.24%). Dysphagia (76.47%) was the most common symptom, followed by regurgitation (8.82%) and reflux (2.94%). Comorbidities were present in 32.35%, most commonly hypertension (11.76%) and diabetes (8.82%). Esophagogastroduodenoscopy (EGD) findings were consistent with achalasia in 48.53%, and esophagogram abnormalities were found in 32.35%, though more than half (54.41%) had no documented abnormalities. HREM findings revealed impaired esophageal motility in most patients, with a median distal contractile integral (DCI) of 805 mmHg•s•cm and incomplete bolus transit in 39.71%. Primary achalasia was the most common disorder, affecting 52.94% (Type I) and 16.18% (Type II), while ineffective esophageal motility (14.71%) and absent peristalsis (7.35%) were also frequently observed. Failed peristalsis was documented in 67.65% of supine wet swallows, 62.69% of multiple rapid swallow tests, and 34.85% of upright swallow tests. This study highlights the high prevalence of esophageal motility abnormalities in patients with non-obstructive dysphagia, with primary achalasia being the most common diagnosis. The findings emphasize the importance of HREM in detecting esophageal dysfunction and guiding clinical management.

Conclusion: The study demonstrates that esophageal motility disorders, especially primary achalasia, are common in patients with non-obstructive dysphagia. Manometric abnormalities, including failed peristalsis and incomplete bolus transit, were prevalent among patients. These findings, classified using the Chicago Classification v4.0, emphasize the critical role of HREM in diagnosing and tailoring treatment for esophageal motility disorders.

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