High resolution oesophageal manometry in the investigation of respiratory symptoms
Thesis or dissertation
- © 2016 Jennifer Burke. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Background: It has been suggested that gastro-oesophageal reflux and aspiration are common precipitants in respiratory diseases such as asthma, COPD, and interstitial lung disease. Several studies have indicated reduced oesophageal motility as a factor in aspiration and poorly controlled gastro-oesophageal reflux causing respiratory symptoms, however, none have provided evidence that the motility profile of this group of patients differ from GORD sufferers exhibiting more typical symptoms. Recent studies have also highlighted the importance of the gastro-oesophageal pressure gradient (GOPG) in the prevalence of reflux.
Method: High Resolution Oesophageal Manometry (HRM) was performed in 121 patients, 61 of whom presented primarily with unexplained respiratory symptom (Group A). An age and sex matched control group was chosen from patients presenting with dyspepsia (Group B). The HRM findings of 61 patients (38 female), mean age 56, range (18-81) with respiratory symptoms were compared with the those of 60 suspected gastrooesophageal reflux disease (GORD) patients (39 female), mean age 57, range (19-81). Respiratory patients complained predominantly of chronic cough (50), or breathlessness (11).
Results: Mean LOS and UOS resting pressures were similar between the two groups. There was a significant difference in the number of intact peristaltic swallows with a larger number of intact swallows in Group B (58% vs 43%, P=0.03) than in Group A. Intraoesophageal pressure was significantly lower during inspiration in group A (-11.5mmHg vs -8.7, p=0.001). Consequently, a significantly higher GOPG was found in group A (46mmHg vs 33mmHg, p<0.01).
Conclusion: Using HRM, we have demonstrated a higher prevalence of oesophageal dysmotility in patients with unexplained respiratory symptoms than those with typical manifestations of GORD - a group in which reduced oesophageal motility is already widely documented. As well as this, we have shown that those with unexplained respiratory symptoms exhibit higher inspiratory GOPGs. Theoretically, our findings support the hypothesis that oesophageal dysmotility and an increased inspiratory GOPG could encourage both acid and non-acid aspiration and thus provoke respiratory symptoms such as cough and breathlessness.
- Hull York Medical School, The University of Hull and University of York
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