Skip to main content
PMC home page
Gut logoLink to Gut
. 1993 Sep;34(9):1158–1161. doi: 10.1136/gut.34.9.1158

Audit of the role of oesophageal manometry in clinical practice.

P W Johnston 1, B T Johnston 1, B J Collins 1, J S Collins 1, A H Love 1
PMCID: PMC1375445  PMID: 8406145

Abstract

This oesophageal laboratory serves a population of 1.5 million. The study aimed to review referral patterns and assess the cost effectiveness of oesophageal manometry in clinical practice. All 276 consecutive manometry studies performed between 1988 and 1991 were reviewed. Reasons for referral in the 268 first referrals were: dysphagia 50.4%, non-cardiac chest pain 23.1%, gastro-oesophageal reflux disease 14.2%, connective tissue disease 11.2%, and 'other' 1.1%. Manometry was normal in 49.3%, showed achalasia in 17.9%, diffuse oesophageal spasm in 13.4%, connective tissue disease in 7.8%, hypertensive lower oesophageal sphincter in 4.5%, nutcracker oesophagus in 2.6%, and 'other' in 4.5%. A positive diagnosis was significantly more common if dysphagia was the reason for referral (65.9% v 35.3%, p < 0.01). A positive diagnosis was established in 60% of patients referred with connective tissue disease, 30.6% with non-cardiac chest pain, and 21.1% with gastro-oesophageal reflux disease. A positive diagnosis was significantly more common in connective tissue disease when symptoms were present (85% v 10%, p < 0.05). Management was changed in 48.9% of all patients because of manometry findings. The cost of each oesophageal manometry study was calculated to be 63.00 pounds: every change in patient management cost 129.00 pounds. In conclusion, oesophageal manometry changed management in over 20% of patients with non-cardiac chest pain or gastro-oesophageal reflux disease and in over 60% of those with dysphagia. It is, therefore, a useful and cost effective test in patients with these symptoms.

Full text

PDF
1161

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blackwell J. N., Castell D. O. Oesophageal chest pain: a point of view. Gut. 1984 Jan;25(1):1–6. doi: 10.1136/gut.25.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Blackwell J. N., Wu W. C., Castell D. O. Clinical applications of oesophageal motility studies? Br J Hosp Med. 1984 Nov;32(5):267–271. [PubMed] [Google Scholar]
  3. Dalton C. B., Castell D. O., Hewson E. G., Wu W. C., Richter J. E. Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci. 1991 Aug;36(8):1025–1028. doi: 10.1007/BF01297441. [DOI] [PubMed] [Google Scholar]
  4. Doria A., Bonavina L., Anselmino M., Ruffatti A., Favaretto M., Gambari P., Peracchia A., Todesco S. Esophageal involvement in mixed connective tissue disease. J Rheumatol. 1991 May;18(5):685–690. [PubMed] [Google Scholar]
  5. Ende J. Mind over manometry. Hosp Pract (Off Ed) 1988 Nov 30;23(11A):4, 7-8, 11. [PubMed] [Google Scholar]
  6. Katz P. O., Dalton C. B., Richter J. E., Wu W. C., Castell D. O. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients. Ann Intern Med. 1987 Apr;106(4):593–597. doi: 10.7326/0003-4819-106-4-593. [DOI] [PubMed] [Google Scholar]
  7. Kline M., Chesne R., Sturdevant R. A., McCallum R. W. Esophageal disease in patients with angina-like chest pain. Am J Gastroenterol. 1981 Feb;75(2):116–123. [PubMed] [Google Scholar]
  8. Meshkinpour H., Glick M. E., Sanchez P., Tarvin J. Esophageal manometry: a benefit and cost analysis. Dig Dis Sci. 1982 Sep;27(9):772–775. doi: 10.1007/BF01391368. [DOI] [PubMed] [Google Scholar]
  9. Robinson M., Allen M. L., Wu W. C. Controversies, dilemmas, and dialogues. In the community hospital setting, what is the role of esophageal manometry? Am J Gastroenterol. 1990 Feb;85(2):129–131. [PubMed] [Google Scholar]
  10. Saraswat V. A., Naik S. R. Esophageal motility testing: shadow and substance. Indian J Gastroenterol. 1990 Jul;9(3):185–186. [PubMed] [Google Scholar]
  11. Shoenut J. P., Sharma G. P. Studies in esophageal motility: five year clinical experience in a Canadian tertiary care hospital. Indian J Gastroenterol. 1990 Jul;9(3):191–194. [PubMed] [Google Scholar]
  12. Ward B. W., Wu W. C., Richter J. E., Hackshaw B. T., Castell D. O. Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol. 1987 Mar;82(3):215–218. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES