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23 August 2018 : Case report  Malaysia

High Resolution Impedance Manometry: A Necessity or Luxury in Esophageal Motility Disorder?

Mistake in diagnosis, Diagnostic / therapeutic accidents, Rare disease

Han Sin Boo1BEF, Ian Chik1E*, Chai Soon Ngiu2D, Shyang Yee Lim3BD, Razman Jarmin1EG

DOI: 10.12659/AJCR.909717

Am J Case Rep 2018; 19:998-1003

Abstract

BACKGROUND: The esophagus can be affected by a variety of disorders that may be primary or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis and further management somewhat challenging. High resolution impedance manometry (HRiM) has established itself as a valuable tool in evaluating esophageal motility disorder. HRiM is superior in comparison with conventional water perfused manometric recordings in delineating and tracking the movement of functionally defined contractile elements of the esophagus and its sphincters, and in distinguishing the luminal pressurization of spastic esophageal contraction from a trapped bolus. Making these distinctions can help to identify achalasia, distal esophageal spasm, functional obstruction, and subtypes according to the latest Chicago Classification of Esophageal Motility Disorders version 3.0.

CASE REPORT: We report a case series of 4 patients that presented with dysphagia; and with the ancillary help of the HRiM, we are able to diagnose esophageal motility disorder and evaluate its pathogenetic mechanism. This approach aids in tailoring each management individually and avoiding disastrous mismanagement.

CONCLUSIONS: From the series of case reports, we believe that HRiM has an important role to play in deciding appropriate management for patients presenting with esophageal motility disorders, and HRiM should be performed before deciding on management.

Keywords: Diagnostic Errors, Esophageal Motility Disorders, Manometry

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923