Apple Sauce Improves Detection of Esophageal Motor Dysfunction During High-Resolution Manometry Evaluation of Dysphagia

Abstract

BackgroundEsophageal manometry utilizes water swallows to evaluate esophageal motor abnormalities in patients with dysphagia, chest pain, or reflux symptoms. Although manometry is the gold standard for evaluation of these symptoms, patients with dysphagia often have normal results in manometry studies.AimThe objective of this work was to test the hypothesis that challenging the esophagus with viscous apple sauce boluses uncovers motor abnormalities in patients with dysphagia not seen when using water swallows.MethodsHigh-resolution esophageal manometry was performed using ten water swallows followed by ten apple sauce swallows in consecutive subjects presenting with dysphagia. Subjects with grossly abnormal water swallow evaluations were excluded. Each swallow was categorized as normal, hypotensive (distal isobaric contour plots of <30 mmHg over >5 cm), or simultaneous (distal esophageal velocity ≥8.0 cm/s). Ineffective esophageal motility (IEM) was defined as ≥30% hypotensive swallows, and pressurization was defined as ≥20% simultaneous pressure waves.ResultsData from 41 subjects was evaluated. Overall, 96.3% of water swallows were normal, 2.9% hypotensive, and 0.7% simultaneous. Only 70.3% of viscous swallows were normal; 16.7% were hypotensive and 13.0% were simultaneous (P < 0.001 all groups). Seven (17.1%) met criteria for IEM, and pressurization with viscous swallows was observed for nine (22.0%). Fourteen subjects (34.1%) had abnormal results from viscous studies. The presence of any abnormal water swallows was predictive of abnormal viscous swallows (OR = 9.00, CI = 2.15–80.0), although the presence of hypotensive or simultaneous water swallows was not associated with IEM (OR = 0.63, CI = 0.16–2.17) or pressurization (OR = 7.00, CI = 0.90–315.4) with viscous apple sauce.ConclusionsApple sauce challenge increased identification of classifiable motor disorders in patients with dysphagia and may be preferred to alternative bolus materials.

Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD

“…15,16 Indeed, we found that MII+/pH+ patients present more frequently abnormalities at MRS compared to patients with MIIÀ/pHÀ. In particular, we observed that DCI-MRS and MRS/WS ratio were lower in patients with impedance-pH evidence of GERD that in those without evidence of GERD.…”

“…15,16 Multiple rapid swallows (MRS) that consists in the administration of five swallows in rapid sequence, represents the simplest provocative maneuver. Indeed, when multiple swallows are rapidly administered, esophageal peristalsis is deeply inhibited, and pronounced LES relaxation ensues.…”

Multiple Rapid Swallow Responses During Esophageal High-Resolution Manometry Reflect Esophageal Body Peristaltic Reserve

“…Other provocative maneuvers such as the use of more viscous material like apple sauce, solid bolus swallows, free water drinking, and test meals have been proposed as tools to uncover abnormalities of esophageal motor function (12,13). Although our study did not utilize these additional maneuvers, there will probably be additional information that can be obtained with judicious use of further provocative measures.…”

The Relationship Between Dysphagia, Pump Function, and Lower Esophageal Sphincter Pressures on High-Resolution Manometry

“…1 The etiology of NOD is associated with primary motility disorders. [2][3][4] Esophageal manometry is considered the gold standard for assessment of esophageal motility. Historically however, conventional manometry has shown poor symptom correlation with manometric findings.…”