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Tu1186

Assessment of Esophageal Motor Function in Patients With SymptomsSuggestive of Esophageal Disorders - Prevalence of Esophageal Dysfunctionand Its Impact of Quality of LifeNoriaki Manabe, Hiroshi Imamura, Hiroaki Kusunoki, Tomoari Kamada, Akiko Shiotani,Kazuhiko Inoue, Jiro Hata, Ken Haruma

Background & Aims: Available prospectively acquired data on the distribution of esophagealmotor abnormalities in patients complaining of symptoms suggestive of esophageal disordersis relatively scarce in Japan, although several studies revealed some differences in the recogni-tion of gastrointestinal (GI) symptoms such as heartburn between Asian countries andWestern countries. There has been few data regarding the association between the symptomand its impact of quality of life. The aim of this study was to evaluate the distribution ofesophageal motor abnormalities in Japanese patients with symptoms suggestive of esophagealdisorders and its impact on the quality of life by using a high-resolution manometry (HRM).Methods: From September 2007 through September 2012, after excluding patients withorganic diseases by using blood tests, ultrasonography, laryngoscope and upper GI endos-copy, 303 consecutive patients including normal subjects (163 men, 140 women; mean age58.0 years) who underwent MII-EM were recruited. Each subject received ten 5-mL roomtemperature boluses of saline solution in HRM examination. They all completed a self-administered 7-point Likert scale questionnaire about their symptoms and health-relatedquality of life (HRQOL) based on results of the Short-Form Health Survey (SF-8) beforeundergoing diagnostic tests. Results: There were 139 patients with globus sensation, 76patients with dysphagia, 33 patients with heartburn, 8 patients with non-cardiac chest painand 47 control subjects. Of all patients, 155 patients (60.5%) had some esophageal motilitydysfunctions. The frequency of esophageal dysfunctions disaggregated by GI symptoms was49.2% for globus sensation, 90.8% for dysphagia, 45.5% for heartburn and 37.5% for non-cardiac chest pain, respectively (Table 1). As to HRQOL disaggregated by symptoms, theSF-8 physical summary score (PSC) of each symptom was significantly lower than that ofthe control subjects (P , 0.01). On the other hand, differences in the SF-8 mental summaryscore (MSC) compared to controls were detected only in patients with globus sensation ordysphagia (P , 0.01): MSC was 45.4±9.0 points in globus sensation, 45.9±7.5 points indysphagia, and 50.2±5.0 points in controls, respectively. Conclusions: Esophageal dysfunc-tions could be detected in 60.5% of Japanese patients suggestive of esophageal disorders.The most common esophageal motility abnormality in patients with globus sensation orheartburn was ineffective esophageal motility, while the most common esophageal motilityabnormality in patients with dysphagia or non-cardiac chest pain was achalasia. Significantdifferences in PSC compared to controls were detected in all patients, while significantdifferences in MSC were only detected in patients with globus sensation or dysphagia.The distribution of esophageal motor abnormalities in patients with symptoms suggestiveof esophageal disorders

NOTE: IEM, ineffective esophageal motility; DES, diffuse esophageal spasm; LES, loweresophageal sphincter

Tu1187

The Effect on Esophageal Motility of Both Acid Reflux and AgingNoriyuki Kawami, Katsuhiko Iwakiri, Hirohito Sano, Yuriko Tanaka, Mariko Umezawa,Yoshio Hoshihara, Choitsu Sakamoto

Background: Reflux esophagitis (RE) is more prevalent in the elderly than in the young andit is thought that one of the reasons for this is that esophageal motility decreases with age.A decrease in esophageal motility, however, may also be caused by esophagitis due to acidreflux itself. The aim of this study is to investigate the effect of both aging and acid refluxon esophageal motility. Methods: 40 young (under 45) healthy subjects (HS) and 40 elderly

S-784AGA Abstracts

(over 65) HS, with neither reflux symptoms nor RE, and 20 elderly patients with mild RE(elderly RE), underwent esophageal high resolution manometry with a 21-lumen perfusedassembly, which monitored pressure in the pharynx, the upper esophageal sphincter, theesophageal body, the LES and the proximal stomach. An infusion port, located 18cm abovethe distal side hole, was used to inject air and expiratory basal LES pressure was referencedto end expiratory intragastric pressure. Primary peristalsis was testedwith 5mlwater swallows,each swallow separated by a 30 second interval and the process repeated 10 times. Secondaryperistalsis was triggered by esophageal distention, using a 20ml bolus of air, which wasinjected rapidly, by hand, into the middle esophagus. After 20 seconds each stimulus wasfollowed by a dry swallow to clear any of the residual air and then repeated 5 times. Results:There was no difference in basal LES pressure, the success rate of primary peristalsis andthe distal contractile integral (DCI) of primary peristalsis between the young HS or theelderly HS groups (Table), but the success rate of secondary peristalsis in the elderly HSgroup was significantly lower than in the young HS group (Table). There was also nodifference in basal LES pressure and the success rate of primary and secondary peristalsisbetween the elderly HS and the elderly RE groups, but the DCI of primary and secondaryperistalsis in the elderly RE group was significantly lower than in the elderly HS group(Table). Conclusions: The decrease in DCI in primary and secondary peristalsis may becaused by esophagitis due to acid reflux itself but aging may also be responsible for thedecrease in the success rate of secondary peristalsis.

median(interquartile range), *p=0.0285 vs. elderly HS, **p=0.0491 vs. elderly HS,***p,0.0001 vs. young HS

Tu1188

Comparison Between Esophageal Dysphagia in Elderly Patients (>69 Years)and Dysphagia in Younger Patients in JapanNoriaki Manabe, Hiroshi Imamura, Hiroaki Kusunoki, Tomoari Kamada, Kazuhiko Inoue,Jiro Hata, Ken Haruma

Background & Aims: Dysphagia in elderly patients has a major effect on nutrition and thequality of life. Although several studies showed that aging itself was associated with changesin esophageal motility, the impact of this on the symptom of dysphagia and quality of lifeis unknown partly because of lack of data concerning esophageal motility in elderly patients.The aim of this study was to determine the manometric diagnoses of elderly patients ( .69years) with dysphagia and to see if these differed from those in younger patients also reportingdysphagia.Methods: From September 2007 through September 2012, after excluding patientswith organic diseases by using blood tests, ultrasonography, laryngoscope and endoscopy,34 consecutive older patients .69 years reporting esophageal dysphagia (11 men, 23 women;mean age 78.1 years) (group A) were compared with those from 24 younger patients alsowith esophageal dysphagia (15 men, 9 women; mean age 30.2 years) (group B) in regardto symptoms, esophageal motility and quality of life. Each patient received ten 5-mL roomtemperature boluses of saline solution and jelly in combined multichannel intraluminalimpedance-esophageal manometry (MII-EM) examination. They all completed a self-adminis-tered 7-point Likert scale questionnaire about their symptoms and health-related quality oflife (HRQOL) based on results of the Short-Form Health Survey (SF-8) before undergoingdiagnostic tests. In this study, we defined a symptom rated by the patient with a Likertscale score of 4 points of higher as a significant symptom according to our previous study.Results: More older patients reported dysphagia as their primary symptom [group A: 22(64.7%) vs. group B: 6 (25.0%), P , 0.01]. Manometric diagnoses were generally similarbetween the two groups, although ineffective esophageal motility tended to be diagnosedmore in group A compared to group B (23.5% in the group A vs. 8.3% in the group B)(Table 1). No significant differences in manometric parameters except for distal esophagealcontractile amplitude were detected (Table 2). There were no significant differences inHRQOL between the two groups: SF-8 physical summary scores were 40.9 ± 10.4 in thegroup A and 41.4 ± 8.6 in the group B, respectively and SF-8 mental summary scores were44.6 ± 10.8 in the group A and 45.6 ± 7.3 in the group B, respectively. Conclusions: Despitedifferences in symptom patterns, broad manometric diagnoses and impairment of HRQOLin the elderly with dysphagia are similar to younger dysphagia patients.Table 1. Manometric diagnoses between the two groups

NOTE. DES, diffuse esophageal spasm; IEM, ineffective esophageal motilityTable 2. Comparison of esophageal motor function between the two groups