Tu1986 Association of Mayo Dysphagia Questionnaire-30 Day Scores to the Chicago Classification Diagnosis of Esophagogastric Junction (EGJ) Outflow Obstruction

Background: The Chicago classification of esophageal motility was developed to facilitate the interpretation of high resolution esophageal pressure topography studies. A notable feature is the hierarchical organization of esophageal motor disorders into those never encountered in normal individuals (e.g. EGJ outflow obstruction) and those that lie outside of statistical norms. Given the frequency with which we detect EGJ outflow obstruction on high resolution manometry, we sought to evaluate the strength of association between manometrically defined EGJ outflow obstruction and the symptom of dysphagia via the Mayo Dysphagia Questionnaire-30 Day (MDQ-30). Methods: All patients presenting to our motility lab from May 2013 to November 2013 to receive high resolution esophageal manometry for any indication were asked to complete the MDQ-30. In total, 62 patients completed both the questionnaire and manometry. Each patient was assigned a dysphagia score based on their response to selected questions involving the symptom of dysphagia. Responses to questions assessing reflux symptoms were not included in the overall score. Given our small sample size, Fisher's exact test was used to evaluate statistical significance between the dysphagia score and the manometric diagnosis of EGJ outflow obstruction, with the level of statistical significance set at a P value of less than .05. Upper endoscopy and esophagram were reviewed in patients with a diagnosis of EJG obstruction to evaluate for underlying pathology. Results: 15 patients (24%) had EGJ outflow obstruction defined as impaired EGJ relaxation with intact peristalsis. This group had a mean MDQ-30 score of 13 whereas the mean score for those without EGJ obstruction (n=47) was 17. In both groups, 40% of patients had dysphagia as the indication for their manometry. Using a cut off dysphagia score of 25, we found no association between the symptom of dysphagia and the finding of EGJ outflow obstruction on manometry with Fisher's exact test (p-value= 1.0). The majority of patients (13/15) with EJG outflow obstruction on manometry received an EGD, EUS and/or esophagram. Of these 13 patients, only 38% were found to have pathology which was benign. These ranged from one peptic distal esophageal stricture, one esophageal ring and one fundoplication on EGD, one patient with a thickened muscularis propria on EUS, and one patient with a narrowed area in the distal esophagus not permitting passage of barium tablet on esophagram. Conclusion: Comparing MDQ-30 dysphagia scores to a diagnosis of EGJ outflow obstruction on high resolution esophageal pressure topography, we find that there is no association between the symptom of dysphagia and the finding of EGJ outflow obstruction. We also conclude that the minority of patients with EGJ outflow obstruction have evidence of pathology on endoscopy or esophagram.