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.
- ambulatory ph monitoring
- gastro-esophageal reflux disease
- GASTROESOPHAGEAL-REFLUX DISEASE
- MULTICHANNEL INTRALUMINAL IMPEDANCE
- LAPAROSCOPIC NISSEN FUNDOPLICATION
- PRESSURE TOPOGRAPHY
- PERISTALTIC DYSFUNCTION
- BOLUS TRANSPORT