Non-invasive Markers of Esophageal Function in Adults

Vanderbilt University Medical Center

Status: Invitation-only

Conditions: Dysphagia

Treatments: Diagnostic Test: MESG; Diagnostic Test: EESG; Diagnostic Test: High resolution manometry (HRM); Other: Clinical measure questionnaires

Study type: Interventional

Funder types: Other

Identifiers

NCT04074356

191280

Details and patient eligibility

About

The investigator proposes to study electrical activity reflective of esophageal motility in adults noninvasively by the use of multichannel electroesophagogram (EESG) and magnetoesophagogram (MESG) recordings.

Full description

Dysphagia, or difficulty with swallowing, is a common symptom affecting nearly 9.4 million individuals or 4% of the US population. High resolution esophageal manometry is currently considered the gold standard test for evaluation and diagnosis of esophageal motility disorders, but given that it requires trans-nasal placement in a conscious patient, this test is highly uncomfortable and associated with significant patient dissatisfaction. There are currently no noninvasive tests or markers available to test esophageal function and motility.

In the upper gastrointestinal system, as in the heart, disruption of the electrical syncytium in disease produces measurable dysrhythmia. Recent modifications of the standard electrogastrogram (EGG) that have increased the number of leads to 25 (termed high-resolution EGG) have allowed enhanced spatio-temporal resolution of electric slow wave activity, and newer analytic techniques. Additionally, the magnetogastrogram (MGG) overcomes many of the inherent limitations of the standard EGG. The goal of this proposal is to harness similar technologies applied to the esophagus to develop high-resolution electroesophagogram (EESG) and magnetoesophagogram (MESG) as noninvasive clinical methods to quantify esophageal function and motility disorders, which could guide intervention for a large number of adult patients.

The main aims in this proposal are to develop a mathematical model of esophageal function and characterize phenotypes of esophageal motility disorders using EESG/MESG in healthy controls and esophageal dysmotility patients and determine how EESG/MESG rhythm and pattern abnormalities relate to physiologic function.

Enrollment: 90 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Adults ≥ 18 years of age who are undergoing HRM for routine standard of care evaluation for esophageal motility.
• Normal control participants (ages ≥ 18 years) who have no known gastrointestinal complications.

Exclusion criteria

• Those with claustrophobia who cannot lie still under the SQUID for the length of time required
• Due to interference with signal acquisition, subjects with contraindication to undergoing an MRI scan as noted in the MRI Safety checklist by Vanderbilt University Medical Center (such as with heart pacemakers, metal implants, or metal chips or clips) will not undergo SQUID, but can still be eligible to do cutaneous EESG.
• Morbid obesity (these patients are potentially unable to lie under the current generation of SQUID devices)
• Patients with a history of cardiac arrhythmias or taking anticoagulants will be excluded

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 3 patient groups

Healthy Controls

Active Comparator group

Description:

Healthy volunteers with no known gastrointestinal complications will be given questionnaires and testing by electroesophagogram (EESG) and magnetoesophagogram (MESG).

Treatment:

Other: Clinical measure questionnaires

Diagnostic Test: EESG

Diagnostic Test: MESG

Achalasia subjects

Active Comparator group

Description:

Subjects who have undergone standard of care high resolution manometry that results in a diagnosis of achalasia will be given questionnaires and testing by electroesophagogram (EESG) and magnetoesophagogram (MESG).

Treatment:

Other: Clinical measure questionnaires

Diagnostic Test: High resolution manometry (HRM)

Diagnostic Test: EESG

Diagnostic Test: MESG

Hypercontractile/spastic disorder subjects

Active Comparator group

Description:

Subjects who have undergone standard of care high resolution manometry that results in a diagnosis of hypercontractile/spastic disorder will be given questionnaires and testing by electroesophagogram (EESG) and magnetoesophagogram (MESG).

Treatment:

Other: Clinical measure questionnaires

Diagnostic Test: High resolution manometry (HRM)

Diagnostic Test: EESG

Diagnostic Test: MESG