Semi-Solid and Solid Bolus Swallows in High-Resolution Oesophageal Manometry for the Detection of Motility Disorders
- 1 School of Medicine, Western Sydney University, Sydney, Australia
- 2 Gastrointestinal Physiology and Urodynamics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
- 3 School of Medicine, Western Sydney University, Sydney, Australia
- 4 Gastroenterology, Campbelltown Hospitals, Campbelltown, Australia
Abstract
Background/Aims: High-resolution oesophageal manometry utilises water swallows to evaluate oesophageal function. However, small volumes of water are not representative of normal eating and as a result often produce normal manometry studies in patients with dysphagia. This study sets out to establish optimal diagnostic thresholds for semi-solid solid swallows and evaluate their ability to uncover motility abnormalities in patients with motility disorders. Method: Manometry was performed using ten 5-mL single water swallows followed by two semi-solid and two solid swallows in the upright position. Normative values for the adjunctive tests were obtained from patient controls while patients with major motility disorders were used to establish the optimal diagnostic thresholds. Diagnostic thresholds identified were prospectively tested in patients with normal water swallows but oesophagus related symptoms and in those with minor and major motility disorders. Results: Normal values for semi-solid and solid were determined in patient controls (n = 100). Development of diagnostic thresholds included 120 patients with major motility disorders. Optimal diagnostic thresholds identified for oesophagogastric junction dysfunction in semi-solid and solid swallows (IRP > 15.5 mmHg). Hypercontractilty and spasm used existing thresholds (>8000 mmHg-s-cm and < 4.5 s, respectively) but modified frequency of ≥50% of adjunctive swallows. Diagnostic thresholds were applied to symptomatic patients with normal water swallows (n = 70) identifying 12/70 (17%) to have abnormal adjunctive swallows. One of 30 patients (3%) with ineffective motility had abnormal adjunctive swallow and 12 patients with oesophageal spasm, oesophagogastric junction obstruction, and hypercontractility had abnormal adjunctive swallows that moved them up the motility disorder hierarchy. Conclusions: Semi-solid and solid challenge increase diagnostic yield of motility disorders.
- Kahrilas, P.J., Bredenoord, A.J., Fox, M., Gyawali, C.P., Roman, S., Smout, A.J., Pandolfino, J.E., International High Resolution Manometry Working Group (2015) The Chicago Classification of Esophageal Motility Disorders, v3.0. Neurogastroenterology & Motility, 27, 160-174. https://doi.org/10.1111/nmo.12477
- Keren, S., Argaman, E. and Golan, M. (1992) Solid Swallowing versus Water Swallowing: Manometric Study of Dysphagia. Digestive Diseases and Sciences, 37, 603-608. https://doi.org/10.1007/BF01307587
- Basseri, B., Pimentel, M., Shaye, O.A., Low, K., Soffer, E.E. and Conklin, J.L. (2011) Apple Sauce Improves Detection of Esophageal Motor Dysfunction during High-Resolution Manometry Evaluation of Dysphagia. Digestive Diseases and Sciences, 56, 1723-1728. https://doi.org/10.1007/s10620-010-1513-x
- Sweis, R., Anggiansah, A., Wong, T., Kaufman, E., Obrecht, S. and Fox, M. (2011) Normative Values and Inter-Observer Agreement for Liquid and Solid Bolus Swallows in Upright and Supine Positions as Assessed by Esophageal High-Resolution Manometry. Neurogastroenterology & Motility, 23, 509-e198. https://doi.org/10.1111/j.1365-2982.2011.01682.x
- Sweis, R., Anggiansah, A., Wong, T., Brady, G. and Fox, M. (2014) Assessment of Esophageal Dysfunction and Symptoms during and after a Standardized Test Meal: Development and Clinical Validation of a New Methodology Utilizing High-Resolution Manometry. Neurogastroenterology & Motility, 26, 215-228. https://doi.org/10.1111/nmo.12252
- Richter, J.E. (1997) Ambulatory Esophageal pH Monitoring. The American Journal of Medicine, 103, 130S-134S. https://doi.org/10.1016/S0002-9343(97)00338-0
- Pandolfino, J.E., Fox, M.R., Bredenoord, A.J. and Kahrilas, P.J. (2009) High-Resolution Manometry in Clinical Practice: Utilizing Pressure Topography to Classify Oesophageal Motility Abnormalities. Neurogastroenterology & Motility, 21, 796-806. https://doi.org/10.1111/j.1365-2982.2009.01311.x
- Ang, D., Hollenstein, M., Misselwitz, B., Knowles, K., Wright, J., Tucker, E., Sweis, R. and Fox, M. (2017) Rapid Drink Challenge in High-Resolution Manometry: An Adjunctive Test for Detection of Esophageal Motility Disorders. Neurogastroenterology & Motility, 29, e12902. https://doi.org/10.1111/nmo.12902
- Fox, M.R. and Bredenoord, A.J. (2008) Oesophageal High-Resolution Manometry: Moving from Research into Clinical Practice. Gut, 57, 405-423. https://doi.org/10.1136/gut.2007.127993
- Allen, M.L., Mellow, M.H. and Robinson, M. (1992) Manometry during Food Ingestion Aids in the Diagnosis of Diffuse Esophageal Spasm. The American Journal of Gastroenterology, 87, 568-571.