AUDIT OF THE ROLE OF ESOPHAGEAL MANOMETRY IN CLINICAL-PRACTICE

This oesophageal laboratory serves a population of 1-5 million. The st udy aimed to review referral patterns and assess the cost effectivenes s of oesophageal manometry in clinical practice. All 276 consecutive m anometry studies performed between 1988 and 1991 were reviewed. Reason s for referral in the 268 first referrals were: dysphagia 50.4%, non-c ardiac chest pain 23.1%, gastro-oesophageal reflux disease 14.2%, conn ective tissue disease 11.2%, and 'other' 1.1%. Manometry was normal in 49.3%, showed achalasia in 17.9%, diffuse oesophageal spasm in 13.4%, connective tissue disease in 7.8%, hypertensive lower oesophageal sph incter in 4.5%, nutcracker oesophagus in 2.6%, and 'other' in 4.5%. A positive diagnosis was significantly more common if dysphagia was the reason for referral (65.9% v 35.3%, p<0.01). A positive diagnosis was established in 60% of patients referred with connective tissue disease , 30.6% with non-cardiac chest pain, and 21.1% with gastro-oesophageal reflux disease. A positive diagnosis was significantly more common in connective tissue disease when symptoms were present (85% v 10%, p<0. 05). Management was changed in 48-9% of all patients because of manome try findings. The cost of each oesophageal manometry study was calcula ted to be 63.00 pounds: every change in patient management cost 129.00 pounds. In conclusion, oesophageal manometry changed management in ov er 20% of patients with non-cardiac chest pain or gastro-oesophageal r eflux disease and in over 60% of those with dysphagia. It is, therefor e, a useful and cost effective test in patients with these symptoms.