Document Detail


Optimizing the swallow protocol of clinical high-resolution esophageal manometry studies.
MedLine Citation:
PMID:  22863083     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Chicago Classification (CC) of Esophageal Motility Disorders is based on 10 water swallows performed in the supine position. The aim of the study was to assess whether upright and provocative swallows (PS) provided important information beyond that obtained from the standard supine manometric protocol.
METHODS: Two independent investigators reviewed high-resolution manometry (HRM) studies of 148 patients with both supine and upright liquid swallows and additional studies from patients with PS (increased volume, viscosity, and a marshmallow) for a resultant change in CC diagnoses. Significant diagnostic changes were defined as a change from normal or borderline motor function to abnormal motor function, esophagogastric junction (EGJ) outflow obstruction, or achalasia. Discordant diagnoses were reviewed and the Kappa test was used to evaluate the agreement between diagnoses in the different protocols.
KEY RESULTS: The overall agreement in diagnosis between the five supine swallows and the five upright swallows was good (k = 0.583). Changing to the upright position elicited a significant diagnostic change in 10.1% (15/148) of cases. The PS suggested an alternative diagnosis from the supine position in 14 of 75 studies (18.7%); 11 of these changed to EGJ obstruction during viscous or solid bolus challenges.
CONCLUSIONS & INFERENCES: Changing position in HRM elicited a significant change in diagnosis in about 10% of studies, whereas provocative bolus challenges with viscous liquid and marshmallows increased the detection of EGJ outflow obstruction. Performing manometric evaluations in both positions with PS may increase the yield of standard HRM technique.
Authors:
Y Xiao; F Nicodème; P J Kahrilas; S Roman; Z Lin; J E Pandolfino
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-08-02
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  24     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-12     Completed Date:  2013-06-04     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e489-96     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2951, USA. yinglian.xiao@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Deglutition / physiology
Esophageal Motility Disorders / diagnosis*
Female
Humans
Male
Manometry / methods*
Middle Aged
Posture*
Young Adult
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK56033/DK/NIDDK NIH HHS
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