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Vol. 46. Issue 1.
Pages 10-16 (January 2023)
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Vol. 46. Issue 1.
Pages 10-16 (January 2023)
Original article
Underlying etiology associated with the diagnosis of absent contractility on high resolution esophageal manometry
Etiologías subyacentes asociadas al diagnóstico de contractilidad ausente en la manometría esofágica de alta resolución
Luis Gerardo Alcalá-Gonzáleza,b, Alba Jimenez-Masipa, Lucia Relea-Pérezc, Claudia Barber-Casellesa,b, Elizabeth Barba-Orozcod,
Corresponding author
BARBA@clinic.cat

Corresponding author.
a Department of Gastroenterology, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
b Facultad de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
c Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Madrid, Spain
d Neurogastroenterology Motility Unit, Department of Gastroenterology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Abstract
Background/Aims

Absent contractility is considered a disorder of peristalsis. The literature about the etiology and clinical characteristics is scarce and the evidence on systemic diseases associated with this esophageal disorder is limited. Therefore, we aimed to determine the etiology of absent contractility in our population using the clinical algorithm recently described in the literature.

Methods

We conducted a retrospective, descriptive study at a single tertiary hospital of all patients diagnosed of absent contractility between May 2018 and February 2020. Data on demographic characteristics, medication, comorbidities, and laboratory and paraclinical tests were recorded from clinical records.

Results

A total of 72 patients with absent contractility were included for analysis. There was a predominance of female sex (n=43, 59.7%), with a mean age of 55.4 (±15.0) years. We identified a systemic disorder associated with absent contractility in 64 (88.9%) patients. From these, 31 (43.1%) patients were diagnosed with a systemic autoimmune disease, 26 (36.1%) patients were considered to have absent contractility secondary to pathological exposure to acid-reflux and 15 (20.8%) patients were diagnosed with other non-autoimmune systemic disorders. In the remaining eight (11.1%) patients, there were no underlying systemic disorders that could justify the diagnosis of absent contractility.

Conclusions

A systematic approach to search for an underlying cause in patients diagnosed with absent contractility is warranted. Up to 90% of patients with absent contractility have a systemic disorder associated with this condition.

Keywords:
Esophageal motility disorders
Absent contractility
Esophagus
High-resolution manometry
Systemic disease
Gastroesophageal reflux
Abbreviations:
AC
CIPO
GERD
HRM
IRP
LES
MCTD
MNGIE
SLE
SSc
Resumen
Antecedentes

La contractilidad ausente se considera un trastorno de la peristalsis esofágica. La literatura que existe sobre la etiología y las características clínicas es escasa y la evidencia sobre enfermedades sistémicas asociadas a este trastorno esofágico es limitada. Nuestro objetivo fue determinar la etiología de la contractilidad ausente en nuestra población utilizando el algoritmo clínico recientemente descrito en la literatura.

Métodos

Se realizó un estudio descriptivo retrospectivo en un hospital terciario de todos los pacientes diagnosticados de ausencia de contractilidad entre mayo de 2018 y febrero de 2020. Se recogieron datos de características demográficas, medicación, comorbilidades y pruebas de laboratorio y estudios paraclínicos.

Resultados

Se incluyeron para el análisis un total de 72 pacientes con ausencia de contractilidad. Predominó el sexo femenino (n=43, 59,7%), con una edad media de 55,4 (±15,0) años. Identificamos un trastorno sistémico asociado con la ausencia de contractilidad en 64 (88,9%) pacientes. De estos 31 (43,1%) pacientes fueron diagnosticados de una enfermedad autoinmune sistémica, 26 (36,1%) pacientes se consideraron con ausencia de contractilidad secundaria a exposición patológica al reflujo ácido y 15 (20,8%) fueron diagnosticados con otras enfermedades no autoinmunes sistémicas. En los 8 pacientes restantes (11,1%) no hubo trastornos sistémicos subyacentes que pudieran justificar el diagnóstico de contractilidad ausente.

Conclusiones

Un enfoque sistemático está justificado para investigar una causa subyacente en pacientes diagnosticados de contractilidad ausente. Hasta el 90% de los pacientes con contractilidad ausente tienen un trastorno sistémico asociado con esta afectación de la motilidad esofágica.

Palabras clave:
Trastornos de la motilidad esofágica
Contractilidad ausente
Esófago
Manometría esofágica de alta resolución
Enfermedad sistémica
Reflujo gastroesofágico

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