Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry.

Misselwitz, Benjamin; Hollenstein, Michael; Bütikofer, Simon; Ang, Daphne; Heinrich, Henriette; Fox, Mark (2020). Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry. Alimentary pharmacology & therapeutics, 51(7), pp. 706-718. Wiley-Blackwell 10.1111/apt.15658

[img] Text
apt.15658.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

BACKGROUND

Standard high-resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position.

AIMS

To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders.

METHODS

Seventy-two healthy volunteers (20-76 years) and 366 consecutive patients (18-90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests.

RESULTS

Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = 0.0007). Similarly, the difference in concordance for the diagnosis of oesophago-gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = 0.0087).

CONCLUSION

Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology

UniBE Contributor:

Misselwitz, Benjamin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0269-2813

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

22 Dec 2020 16:56

Last Modified:

22 Dec 2020 16:56

Publisher DOI:

10.1111/apt.15658

PubMed ID:

32056267

BORIS DOI:

10.7892/boris.149318

URI:

https://boris.unibe.ch/id/eprint/149318

Actions (login required)

Edit item Edit item
Provide Feedback