Explore functional aspects including contraction onset velocity and contraction amplitude cut-off values for simultaneous contractions to predict complete bolus transit.
We re-examined data from 107 impedance-manometry recordings with a diagnosis of distal oesophageal spasm. Receiver operating characteristic analysis was conducted, regarding effects of onset velocity on bolus transit taking into account distal oesophageal amplitude and correcting for intra-individual repeated measures.
Mean area under the receiver operating characteristic curve for saline and viscous swallows were 0.84 卤 0.05 and 0.84 卤 0.04, respectively. Velocity criteria of >30 cm/s when distal oesophageal amplitude > 100 mmHg and 8 cm/s when distal oesophageal amplitude < 100 mmHg for saline and 32 cm/s when distal oesophageal amplitude > 100 mmHg and >7 cm/s when distal oesophageal amplitude < 100 mmHg for viscous had a sensitivity of 75%and specificity of 80%to identify complete bolus transit. Using these criteria, final diagnosis changed in 44.9%of patients. Abnormal bolus transit was observed in 50.9%of newly diagnosed distal oesophageal spasm patients versus 7.5%of patients classified as normal. Distal oesophageal spasm patients with distal oesophageal amplitude > 100 mmHg suffered twice as often from chest pain than those with distal oesophageal amplitude < 100 mmHg.
The proposed velocity cut-offs for diagnosing distal oesophageal spasm improve the ability to identify patients with spasm and abnormal bolus transit.