Association of Esophageal Spasm Diagnosed by Barium Esophagram Compared to Esophageal Spasm Diagnosed by High-Resolution Esophageal Manometry

Abstract

Context: High-resolution esophageal manometry is classically used to evaluate esophageal spasm; however, esophageal spasm is also commonly diagnosed via barium esophagram. It is unknown if spasm diagnosed on barium esophagram is associated with esophageal spasm diagnosed on high-resolution esophageal manometry (HREM).

Objective: We aim to evaluate if esophageal spasm diagnosed on barium esophagram is associated with esophageal spasm diagnosed on high-resolution esophageal manometry.

Design: Retrospective study of patients who underwent high-resolution esophageal manometry evaluation and had a barium esophagram performed with six months of their esophageal manometry date.

Setting: Outpatient high-resolution esophageal manometry and barium esophagram studies from a single tertiary-care medical center

Patients: 410 adult patients, age 18 and older, who underwent high-resolution esophageal manometry. Of the 410 patients, 212 also underwent barium esophagram within six months of manometry testing and were included in the analysis.

Main Outcome Measures: To evaluate if esophageal spasm diagnosed on high-resolution esophageal manometry is associated with esophageal spasm diagnosed on barium esophagram, measured by the odds ratio comparing the presence or absence of esophageal spasm on high-resolution esophageal manometry with the presence or absence of spasm on barium esophagram. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated.

Results: Patients were divided into spasm on esophageal manometry (SEM) and no spasm on esophageal manometry (NSEM) groups. Of the 212 patients, 23 (10.85%) were included in the SEM group with the remaining 171 (80.66%) included in the NSEM group. Esophagram had a sensitivity of 60.87% (95% CI 38.54-80.29%), specificity of 54.50% (95% CI 47.11-61.74%), PPV of 14.00% (95% CI 10.17-18.96%), and NPV of 91.96% (95% CI 87.12-95.09%) for diagnosis of esophageal spasm compared to HREM. Multivariable logistic regression model regressing manometry diagnosis of spasm on to esophagram diagnosis of spasm demonstrated an odds ratio of 1.83 [95% CI (0.72-4.62), p=0.2] after adjustment for age, gender, indication for testing, and days between esophagram and manometry testing.

Conclusions: Comparison of esophageal spasm diagnosed on barium esophagram compared to esophageal spasm diagnosed on high-resolution esophageal manometry did not demonstrate a statistically significant association.