Objective: To characterize esophageal symptoms in PD using high-resolution Manometry.

Background: Dysphagia is common in PD; its etiology multifactorial and its management challenging. In a retrospective cohort analysis we aimed to objectively characterize dysphagia and/or other esophageal symptoms in PD, assess the prevalence of outflow obstruction, disorders of esophageal peristalsis leading to impaired esophageal clearance and highlight objective parameters that can help in current management. In a prospective cohort of PD patients we evaluated intrapersonal variability of these esophageal motility findings in patients with various disease stages and with or without esophageal symptoms. 

Methods: 33 patients with PD presenting with dysphagia, odynophagia, heartburn, regurgitation, chest pain and weight loss underwent clinical and functional evaluation by HRM.  Esophago-gastric junction (EGJ) outflow obstruction and major as well as minor disorders of peristalsis were then retrospectively assessed using the Chicago classification (v3).  

Results: 33 PD patients with esophageal symptoms were enrolled in the retrospective study; 12 reported weight loss that was considered as potentially reflecting underlying esophageal dysfunction. The median age was 70 years (range 53-89 years), 24 (75%) were men. The majority (62%) experienced dysphagia, likely contributing to weight loss in 41% of patients. Odynophagia was rare (6%) while GER symptoms, such as heartburn, regurgitation and chest pain were noted in 37%, 31% and 28% of patients respectively. Using the hierarchy of the Chicago classification (v3), 12 patients (39%) exhibited EGJ outflow obstruction, 16 (48%) diffuse esophageal spasm (DES), 18 (55%), ineffective esophageal peristalsis (IEM), 16 (48%) fragmented peristalsis, and only 2 patients (6%) had normal HRM tracings. There were no patients with HRM features of achalasia.

Conclusions: Dysphagia is common in PD and is associated with a high prevalence of underlying motility disturbances as identified by HRM. The exact impact of these motility abnormalities on symptom induction, their variability over time in the same patient, their evolution as well as their role in influencing clinical management are still unclear and will require further prospective study and validation. 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/high-resolution-manometry-hrm-in-parkinsons-disease-pd/