The diagnostic values of particular symptoms centred on oesophagus, among patients with suspected oesophageal motility abnormality or pathological
acid exposure, are not yet fully understood. The aim of this study was to determine the predictive accuracy of these symptoms in diagnosis of oesophageal motility disorder or pathological
acid exposure. PATIENTS AND METHODS.: A total of 462 patients who had undergone conventional oesophageal manometry and ambulatory 24-h pH monitoring to investigate a clinical suspicion of oesophageal motility disorder and pathological
acid exposure were enrolled in this study. According to their principal complaints, the patients were divided into the
dysphagia category, the non-cardiac
chest pain category, the gastrooesophageal reflux disease-related symptom category and the extraoesophageal symptom category.
RESULTS: Two hundred and two (44%) out of 462 patients yielded abnormal findings on manometry and/or pH monitoring.
Dysphagia was associated with a likelihood ratio (LR) of 2.11 [95% confidence interval (CI), 1.02-4.00)] in patients exhibiting a combination of oesophageal motility abnormality and pathological
acid exposure. During oesophageal manometry, the
dysphagia substantially increased the likelihood of classic
achalasia (LR, 6.24; 95% CI, 3.32-8.78) and diffuse oesophageal
spasm (LR, 3.58; 95% CI, 1.03-7.12). When the patients with
dysphagia were divided into two groups according to the severity of their symptoms, classic
achalasia was significantly frequent in patients with severe
dysphagia (P = 0.016). On the other hand, non-cardiac
chest pain was the clinical factor that reduced the likelihood of classic
achalasia (LR, 0.22; 95% CI, 0.04-0.93). The distribution of pathological
acid exposure was significantly frequent between the groups of patients with and without gastrooesophageal reflux disease-related symptom (P = 0.011).
CONCLUSION: A small number of oesophageal symptoms are helpful in predicting the likelihood of abnormal findings on oesophageal tests among patients with a clinical suspicion of oesophageal motility disorder and pathological
acid exposure. The most useful finding is a severe
dysphagia, which is likely to have classic
achalasia.