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

TY - JOUR

T1 - Assessment of esophageal dysfunction and symptoms during and after a standardized test meal

T2 - development and clinical validation of a new methodology utilizing high-resolution manometry

AU - Sweis, R.

AU - Anggiansah, A.

AU - Wong, Terry

AU - Brady, G.

AU - Fox, M.

PY - 2014/2

Y1 - 2014/2

N2 - Background In the absence of major dysmotility, esophageal manometry with water swallows rarely explains the causes of esophageal symptoms and disease. This methodology development study assessed esophageal function and symptoms during a test meal in patients with reflux symptoms and asymptomatic controls. The impact of this approach on manometric diagnosis and clinical outcome was reviewed.Methods18 patients with reflux symptoms and 10 healthy volunteers underwent high resolution manometry (HRM) with 5mL water swallows, 200mL water drink, and standardized solid test meal followed by 10min postprandial observation. The number of symptoms associated with esophageal dysfunction (SAD) divided by total symptoms (dysfunction symptom index [D-SI]) was calculated. Ambulatory reflux pH-monitoring was performed. Final diagnosis and clinical outcome were documented at 2years.Key ResultsMeal intake took longer in patients than controls (552 vs 339s) and this was associated with a higher number of ineffective swallows in this group (51% vs 28%; p50% in 9/12 (75%). Compared with water swallows, manometric classification was altered in 12/18 (67%) and clinical diagnosis was altered in 7/18 (39%) patients due to test meal observations.Conclusions & InferencesA novel methodology for the detection of symptomatic dysmotility during a test meal and postprandial observation is presented. This technique increased the diagnostic yield of esophageal dysfunction in patients presenting with reflux symptoms. Long-term follow-up indicated that these observations can guide effective clinical management.

AB - Background In the absence of major dysmotility, esophageal manometry with water swallows rarely explains the causes of esophageal symptoms and disease. This methodology development study assessed esophageal function and symptoms during a test meal in patients with reflux symptoms and asymptomatic controls. The impact of this approach on manometric diagnosis and clinical outcome was reviewed.Methods18 patients with reflux symptoms and 10 healthy volunteers underwent high resolution manometry (HRM) with 5mL water swallows, 200mL water drink, and standardized solid test meal followed by 10min postprandial observation. The number of symptoms associated with esophageal dysfunction (SAD) divided by total symptoms (dysfunction symptom index [D-SI]) was calculated. Ambulatory reflux pH-monitoring was performed. Final diagnosis and clinical outcome were documented at 2years.Key ResultsMeal intake took longer in patients than controls (552 vs 339s) and this was associated with a higher number of ineffective swallows in this group (51% vs 28%; p50% in 9/12 (75%). Compared with water swallows, manometric classification was altered in 12/18 (67%) and clinical diagnosis was altered in 7/18 (39%) patients due to test meal observations.Conclusions & InferencesA novel methodology for the detection of symptomatic dysmotility during a test meal and postprandial observation is presented. This technique increased the diagnostic yield of esophageal dysfunction in patients presenting with reflux symptoms. Long-term follow-up indicated that these observations can guide effective clinical management.

KW - ambulatory ph monitoring

KW - dysphagia

KW - gastro-esophageal reflux disease

KW - Manometry

KW - GASTROESOPHAGEAL-REFLUX DISEASE

KW - MULTICHANNEL INTRALUMINAL IMPEDANCE

KW - LAPAROSCOPIC NISSEN FUNDOPLICATION

KW - PRESSURE TOPOGRAPHY

KW - PERISTALTIC DYSFUNCTION

KW - BOLUS TRANSPORT

KW - CLASSIFICATION

KW - MOTILITY

KW - ABNORMALITIES

KW - DYSPHAGIA

U2 - 10.1111/nmo.12252

DO - 10.1111/nmo.12252

M3 - Article

SN - 1350-1925

VL - 26

SP - 215

EP - 228

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

IS - 2

ER -