High-Resolution Esophageal Manometry in Mongolia: The First National Experience and Diagnostic Spectrum of Esophageal Motility Disorders

Background: High-resolution esophageal manometry (HREM) is the reference standard for evaluating esophageal motility disorders; however, data from low- and middle-income countries remain limited. As HREM has only recently become available in Mongolia, this study aimed to provide the first comprehensive characterization of HREM in Mongolia by characterizing referral patterns, the diagnostic spectrum of esophageal motility disorders, and clinical factors associated with major motility disorders. Methods: We conducted a retrospective observational study of 998 consecutive adults who underwent HREM at Intermed IUHW Hospital, the only center currently providing routine clinical HREM services in Mongolia (n = 998). Manometric findings were interpreted according to the Chicago Classification version 4.0. Multivariable logistic regression was performed as an exploratory analysis to identify clinical factors independently associated with major esophageal motility disorders. A sensitivity analysis was performed after excluding patients with a manometric esophagogastric junction outflow obstruction (EGJOO) pattern. Results: Overall, 696 (69.7%) patients were referred for evaluation of suspected gastroesophageal reflux disease or for preoperative anti-reflux assessment, whereas 302 (30.3%) were referred because of suspected esophageal motility disorders. Normal esophageal motility was identified in 61.9% of patients, while ineffective esophageal motility was the most common abnormal finding (26.9%). Major esophageal motility abnormalities were identified in 11.2% of patients, most commonly a manometric EGJOO pattern (6.4%) and achalasia (2.7%). Increasing age (adjusted odds ratio [aOR] 1.35 per 10-year increase, 95% CI 1.12–1.61), lower body mass index (aOR 0.90 per kg/m2, 95% CI 0.85–0.95), dysphagia (aOR 1.95, 95% CI 1.20–3.15), and referral for suspected motility disorders (aOR 5.47, 95% CI 3.22–9.31) were independently associated with major esophageal motility abnormalities. The exploratory model demonstrated moderate discrimination (AUC 0.791, 95% CI 0.741–0.840). Conclusions: Most patients undergoing HREM demonstrated either normal esophageal motility or ineffective esophageal motility, whereas major motility abnormalities were relatively uncommon. Older age, lower body mass index, dysphagia, and referral for suspected motility disorders were independently associated with major motility abnormalities. These findings provide baseline data on the diagnostic spectrum of HREM among referred patients in Mongolia and may inform future prospective studies of HREM referral strategies.