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.
References
[1]
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
[2]
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
[3]
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
[4]
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
[5]
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
[6]
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
[7]
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
[8]
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
[9]
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
[10]
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.
[11]
Bohn, B., Bonaz, B., Gueddah, N., Rolachon, A., Papillon, E., Bost, R. and Fournet, J. (2002) Oesophageal Motor and Sensitivity Abnormalities in Non-Obstructive Dysphagia. European Journal of Gastroenterology & Hepatology, 14, 271-277.
https://doi.org/10.1097/00042737-200203000-00011
[12]
Ang, D., Misselwitz, B., Hollenstein, M., Knowles, K., Wright, J., Tucker, E., Sweis, R. and Fox, M. (2017) Diagnostic Yield of High-Resolution Manometry with a Solid Test Meal for Clinically Relevant, Symptomatic Oesophageal Motility Disorders: Serial Diagnostic Study. Lancet Gastroenterology & Hepatology, 2, 654-661.
https://doi.org/10.1016/S2468-1253(17)30148-6
[13]
Hollenstein, M., Thwaites, P., Butikofer, S., Heinrich, H., Sauter, M., Ulmer, I., Pohl, D., Ang, D., Eberli, D., Schwizer, W., et al. (2017) Pharyngeal Swallowing and Oesophageal Motility during a Solid Meal Test: A Prospective Study in Healthy Volunteers and Patients with Major Motility Disorders. Lancet Gastroenterology & Hepatology, 2, 644-653. https://doi.org/10.1016/S2468-1253(17)30151-6
[14]
Dantas, R.O., Kern, M.K., Massey, B.T., Dodds, W.J., Kahrilas, P.J., Brasseur, J.G., Cook, I.J. and Lang, I.M. (1990) Effect of Swallowed Bolus Variables on Oral and Pharyngeal Phases of Swallowing. American Journal of Physiology, 258, G675-G681.
https://doi.org/10.1152/ajpgi.1990.258.5.G675
[15]
Butler, S.G., Stuart, A., Castell, D., Russell, G.B., Koch, K. and Kemp, S. (2009) Effects of Age, Gender, Bolus Condition, Viscosity, and Volume on Pharyngeal and Upper Esophageal Sphincter Pressure and Temporal Measurements during Swallowing. Journal of Speech Language and Hearing Research, 52, 240-253.
https://doi.org/10.1044/1092-4388(2008/07-0092)
[16]
Hong, S.J., Bhargava, V., Jiang, Y.F., Denboer, D. and Mittal, R.K. (2010) A Unique Esophageal Motor Pattern That Involves Longitudinal Muscles Is Responsible for Emptying in Achalasia Esophagus. Gastroenterology, 139, 102-111.
https://doi.org/10.1053/j.gastro.2010.03.058
[17]
Bredenoord, A.J., Fox, M., Kahrilas, P.J., Pandolfino, J.E., Schwizer, W. and Smout, A.J., International High Resolution Manometry Working Group (2012) Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography. Neurogastroenterology & Motility, 24, 57-65.
https://doi.org/10.1111/j.1365-2982.2011.01834.x
[18]
Dogan, I., Puckett, J.L., Padda, B.S. and Mittal, R.K. (2007) Prevalence of Increased esophageal Muscle Thickness in Patients with Esophageal Symptoms. The American Journal of Gastroenterology, 102, 137-145.
https://doi.org/10.1111/j.1572-0241.2006.01003.x
[19]
Zhang, X., Xiang, X., Tu, L., Xie, X. and Hou, X. (2013) Esophageal Motility in the Supine and Upright Positions for Liquid and Solid Swallows through High-Resolution Manometry. Journal of Neurogastroenterology and Motility, 19, 467-472.
https://doi.org/10.5056/jnm.2013.19.4.467
