Background/Aims: High-resolution manometry with the Chicago classification scheme has been introduced in clinical practice as a gold standard for esophageal motility test. This study aims to evaluate the diagnostic yield of high-resolution manometry in Thai patients. Methods: All available high-resolution esophageal manometry (HREM) studies performed during the study period were retrospectively reviewed and interpreted according to the Chicago classification version 3.0. The main esophageal symptoms and coexisting factors were correlated with the HREM findings. Results: Of the 201 patients, nearly half (49.8%) were documented to have dysphagia. The second most common condition was refractory reflux symptoms (17.4%). More than 70.0% of dysphagia patients showed abnormal esophageal motility, contrary to globus patients who mostly had normal test findings (65.4%). Dysphagia still was the most often correlated condition with major esophageal motility disorders (88.7%), particularly the elderly patients who have coexisting weight loss. Endoscopic and/or surgical procedures were revealed for the highest rate among patients with dysphagia but no one in the globus group needed this intervention. The sensitivity and specificity of dysphagia for major esophageal motility disorders were 70.0% and 67.0%. A much lower sensitivity and higher specificity were found in other non-dysphagia symptoms, especially nausea/vomiting or belching (3.0% or 89.0%). The highest positive likelihood ratio (2.10) to detect major abnormalities was also observed in dysphagia. Conclusion Esophageal manometry provided the highest yield in dysphagia; it was not a strongly beneficial test in patients presenting with nondysphagia to identify clinically relevant esophageal motor disorders.

Background/Aims: High-resolution manometry with the Chicago classification scheme has been introduced in clinical practice as a gold standard for esophageal motility test. This study aims to evaluate the diagnostic yield of high-resolution manometry in Thai patients. Methods: All available high-resolution esophageal manometry (HREM) studies performed during the study period were retrospectively reviewed and interpreted according to the Chicago classification version 3.0. The main esophageal symptoms and coexisting factors were correlated with the HREM findings. Results: Of the 201 patients, nearly half (49.8%) were documented to have dysphagia. The second most common condition was refractory reflux symptoms (17.4%). More than 70.0% of dysphagia patients showed abnormal esophageal motility, contrary to globus patients who mostly had normal test findings (65.4%). Dysphagia still was the most often correlated condition with major esophageal motility disorders (88.7%), particularly the elderly patients who have coexisting weight loss. Endoscopic and/or surgical procedures were revealed for the highest rate among patients with dysphagia but no one in the globus group needed this intervention. The sensitivity and specificity of dysphagia for major esophageal motility disorders were 70.0% and 67.0%. A much lower sensitivity and higher specificity were found in other non-dysphagia symptoms, especially nausea/vomiting or belching (3.0% or 89.0%). The highest positive likelihood ratio (2.10) to detect major abnormalities was also observed in dysphagia. Conclusion Esophageal manometry provided the highest yield in dysphagia; it was not a strongly beneficial test in patients presenting with nondysphagia to identify clinically relevant esophageal motor disorders.

Objective: To develop a predictive model using the risk factors of gestational diabetes mellitus (GDM) and construct a predictive nomogram for GDM risk in women during early pregnancy. Methods: A prospective study was conducted in two tertiary hospitals among pregnant women with gestational age ≤14 weeks. Early GDM was diagnosed if an abnormal 100 g oral glucose tolerance test was detected using the Carpenter and Coustan criteria after an abnormal 50 g glucose challenge test. The factors included in the model were ACOG risk factors; maternal age; family history of hypertensive disorder in pregnancy; family history of dyslipidemia; gravida; parity; histories of preterm birth, early fetal death, abortion, stillbirth, and low birth weight; and glycated hemoglobin (HbA1c) levels. The predictive models for early GDM were analyzed using multiple logistic regression analyses. The nomograms were constructed, and their discrimination ability and predictive accuracy were tested. Results: Of the 553 pregnant women, 54 (9.8%) were diagnosed with early GDM. In the integrated model, there was a history of GDM (adjusted odds ratio [aOR], 5.15; 95% confidence interval [CI], 1.82-14.63; P=0.004), HbA1c threshold ≥5.3% (aOR, 2.61; 95% CI, 1.44-4.74; P=0.002), and family history of dyslipidemia (aOR, 2.68; 95% CI, 1.37-5.21; P=0.005). The integrated nomogram model showed that a history of GDM had a high impact on the risk of early GDM. Its discrimination and mean absolute error were 0.76 and 0.009, respectively. Conclusion Application of the predictive model and nomogram will help healthcare providers investigate the probability of early GDM, especially in resource-limited countries.