P1826 - Rates of Diagnosis of Ineffective Esophageal Manometry and Esophago-Gastric Junction Outflow Obstruction in Patients With and Without Hiatal Hernia Using Chicago 4.0 vs Chicago 3.0

Vinay Jahagirdar, MD¹, Jagadish Koyi, MD¹, Abbas Bader, ², Mir Zulqarnain, DO¹, Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Mohamed Ahmed, MD¹, Thomas Bierman, MD¹, Tahar Malek Mahmoudi, MD¹, Esmat Sadeddin, MD¹, Hassan Ghoz, MD^1
1University of Missouri-Kansas City, Kansas City, MO; ²University of Missouri Kansas City, Kansas City, MO

Introduction: High-Resolution Manometry (HRM) is useful to evaluate coexisting hiatal hernia (HH) and detect associated esophagogastric junction outflow obstruction (EGJOO) prior to surgery for GERD. The Chicago Classification (CC) is used to classify esophageal dysmotility disorders using metrics from high-resolution manometry (HRM). Using CCv3.0 (2015), ineffective esophageal motility (IEM) and EJGOO were often diagnosed in the absence of associated symptoms. To overcome this limitation, CCv4.0, the newest iteration, was released in 2021. HH may disrupt the regional anatomy and alter HRM readings. Our aim was to see whether there was any difference in IEM and EGJOO diagnoses among patients with HH using CCv4.0 vs CCv3.0.

Methods: A retrospective study was conducted on 98 consecutive patients who underwent HRM at our safety net hospital, between January 1, 2021 to March 31, 2023. HRM was performed with inSIGHT Ultima (Sandhill Scientific, CO). Demographic details, esophagogastroduodenoscopy (EGD), and HRM findings were noted. GI clinic visit notes before and after HRM were reviewed. Analysis was performed using SPSS version 28.0. Normally distributed data were presented by mean (± SD). Chi-test was used to compare categorical data. A two-tailed p-value < 0.05 was considered statistically significant.

Results: The mean age of 98 patients was 52.6 ± 13.6 years, and the mean BMI was 31 ± 7.2 kg/m². 72.5% were female. The most common indications for EGD were dysphagia (60.2%), dyspepsia (16.3%), acid reflux (10.2%), and abnormal esophagus on imaging (4%). Hiatal hernia was identified on EGD in 31.6%. 17.2% had esophagitis and 68.9% had esophagitis on EGD. 35.8% were on NSAIDs, 22.5% on SSRI, 9% on oral narcotics, and 100% were on PPI prior to manometry. Dysphagia (64.3%) and reflux (26.5%) were the most common indications for manometry. Rates of diagnosis of IEM and EGJOO are in Table 1.



The rate of diagnosis of IEM using CCv4.0 was comparable to CCv3.0 (24.5% vs 19.4%, p=0.49), even in patients with HH (29% vs 19.4%, p=0.55). Rates of diagnosis of EGJOO were significantly lower using CCv4.0 and CCv3.0 (10.2% vs 2%, p=0.03), but not in patients with HH (6.5% vs 3.2%, p=1).

Discussion: The rate of EGJGOO diagnosis was significantly lower using CCv4.0 than CCv3.0. Though the definition of IEM is more stringent in CCv4.0, we found that rate of diagnosis of IEM was similar in both versions, even in patients with HH. We plan to extend our cohort and look further into this.


Disclosures:


Vinay Jahagirdar, MD¹, Jagadish Koyi, MD¹, Abbas Bader, ², Mir Zulqarnain, DO¹, Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Mohamed Ahmed, MD¹, Thomas Bierman, MD¹, Tahar Malek Mahmoudi, MD¹, Esmat Sadeddin, MD¹, Hassan Ghoz, MD¹. P1826 - Rates of Diagnosis of Ineffective Esophageal Manometry and Esophago-Gastric Junction Outflow Obstruction in Patients With and Without Hiatal Hernia Using Chicago 4.0 vs Chicago 3.0, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.