P0404 - Unveiling the Invisible: Exploring Esophageal Motility Disorders in Rural and Urban Populations

Karissa Lambert, MD¹, Christin Wilkinson, MD¹, Yadis Arroyo, MD², Subanandhini Subramaniam. Parameshwari, MD³, Carlos Anciano, MD¹, Mohamed Khalaf, MD^1
1ECU Health, Greenville, NC; ²Medical University of South Carolina, Charleston, SC; ³East Carolina University Brody School of Medicine, Greenville, NC

Introduction: The updates of the Chicago Classification v4.0 (CC4) were geared to provide more standardized criteria for patterns of esophageal motility disorders (EMDs) and esophagogastric junction dysfunction; yet, the prevalence of EMDs is elusive with the updated classification. Furthermore, data is lacking on the geographical and/or regional differences in EMD prevalence and its demographics, clinical, and manometric characteristics. Our aim is to compare the prevalence of EMDs and its patient demographics, clinical and manometric characteristics in rural and urban settings, represented by ECU Health (Greenville, NC) and MUSC (Charleston, SC), respectively. Physician awareness of motility testing indications will also be compared.

Methods: A retrospective review of prospectively collected manometry reports, using CC4, from 1/2022-12/2022 at ECU Health and MUSC was performed. The data collected included demographics, indication, referring provider specialty, and diagnosis.

Results: 480 consecutive patients were included, 240 from each center. The average age for ECU was significantly older than MUSC (61 vs 58 yrs, respectively) (P< 0.009). Female gender was predominant in both groups, however, significantly higher at ECU (75%) vs MUSC (62%) (P< 0.002). At MUSC, a variety of specialties (predominantly GI), utilized the motility lab services; while at ECU, only surgeons (69%) and GI (31%) referred patients for testing (Figure 1). Dysphagia was the main indication at both (31% vs 35%) (P< 0.2). The diagnostic distribution of EMDs at ECU vs MUSC were as follows: normal (54% vs 53%), IEM (20 % vs 20%), achalasia (5% vs 10%), DES (9% vs 4%), hypercontractile (6% vs 4%), EGJOO (10% vs 8%), absent contractility (2% vs 6%) (Table 1)

Discussion: Rural setting had higher proportion of older individuals and females compared to urban. Interestingly, at Rural ECU, surgeons and to a lesser extent GIs utilized motility testing, highlighting the limited knowledge of referring providers regarding this diagnostic method in the rural setting. While both centers had predominantly encountered IEM, urban MUSC had significantly higher prevalence of achalasia and absent contractility. This could be attributed to the fact that rare conditions like these are spread across multiple large referral centers in North Carolina, as opposed to South Carolina. Further research is necessary to identify potential obstacles to diagnosing and managing EMDs in rural populations.




Disclosures:


Karissa Lambert, MD¹, Christin Wilkinson, MD¹, Yadis Arroyo, MD², Subanandhini Subramaniam. Parameshwari, MD³, Carlos Anciano, MD¹, Mohamed Khalaf, MD¹. P0404 - Unveiling the Invisible: Exploring Esophageal Motility Disorders in Rural and Urban Populations, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.