Diagnostic yield of adding solid food swallows during high‐resolution manometry in esophageal motility disorders

Araujo, Isis K.; Roman, Sabine; Napoléon, Marie; Mion, François

doi:10.1111/nmo.14060

Cited by 12 publications

(4 citation statements)

References 26 publications

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“…Provocative testing is easy, cheap, and confirmed to be useful for defining other minor and major motility disorders. 2,3,8,24,28,29 Our study showed that overall, 44.9% of patients demonstrated different manometric features during the SM, compared to the standard SWS. RDC has been shown to be an effective measure of obstruction in patients with achalasia in several studies.…”

Section: Discussionmentioning

confidence: 60%

“…On the other hand, during the SM, although 70 patients had SWS diagnosis reaffirmed, in 57 (44.9%) the diagnosis changed to a different phenotype of achalasia. Studies have repeatedly demonstrated that the inclusion of solids during HRM has the ability to change diagnosis, and therefore improve the diagnostic yield 2,11,28,29 . Ang et al described how achalasia subtype changed in five patients after solids were introduced with spasm and hypercontractile patterns becoming apparent 2 …”

Section: Discussionmentioning

confidence: 99%

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Assessing the diagnostic yield of achalasia using provocative testing in high‐resolution esophageal manometry: Serial diagnostic study

Dervin,

Endersby,

Sanagapalli

et al. 2023

Neurogastroenterology Motil

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BackgroundChicago Classification v4.0 recommends that if achalasia is demonstrated with single water swallows (SWS); provocative testing is not required. We determine whether provocative testing in patients with suspected achalasia can change manometric findings and reproduce symptoms.MethodsBetween 2016 and 2022, 127 consecutive manometry studies of patients with achalasia were retrospectively analyzed. All patients underwent SWS, a solid meal (SM) and/or a rapid drink challenge (RDC). Demographic data, fluoroscopy, gastroscopy, and pre‐and post‐treatment Eckardt scores were collated.Key ResultsOf 127 achalasia patients (50.6 ± 16.6 years and 54.6% male), all completed a SM and 116 (91.3%) completed RDC; overall 83 were naïve (65.4%) to previous therapy. 15.4% patients with normal integrated relaxation pressure (IRP) on SWS demonstrated obstruction with RDC. SM gave a different achalasia phenotype in 44.9% of patients (p ⟨ 0.001). Twelve patients with normal IRP during SWS had persistent/recurrent obstruction during provocative testing; 83.3% had previous achalasia therapy. None of 13 patients with Type III (TIII) achalasia with SWS exhibited a change in manometric findings with provocative testing. Impedance bolus heights were lower in patients with TIII achalasia and those with normal IRP with SWS. During the SM, symptoms were reproduced in 56.7% of patients. Forty‐six of 103 patients (44.7%) underwent therapy based upon the final achalasia subtype which was defined by the provocative test result of the high‐resolution manometry (HRM) study. All treatments were effective, regardless of the achalasia subtype.Conclusions and InferencesManometric findings remain unchanged when TIII achalasia is diagnosed with SWS. In patients with normal IRP, Type I, or Type II achalasia during SWS, provocative testing can alter achalasia phenotype or uncover achalasia where diagnosis is unclear. Further, it can reproduce symptoms. Such findings can personalize and guide effective therapeutic decisions.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Assessing the diagnostic yield of achalasia using provocative testing in high‐resolution esophageal manometry: Serial diagnostic study

Dervin,

Endersby,

Sanagapalli

et al. 2023

Neurogastroenterology Motil

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“…The upright posture better replicates normal eating and improves detection of motility disorders (200) and hiatal herniation (244). If findings are equivocal, solid foods may be administered (245,246) or post-prandial monitoring ( 247) is performed to improve diagnostic yield.…”

Section: Methodsmentioning

confidence: 99%

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

et al. 2022

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Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.

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“…The previous Chicago classification version 3 (CCv3.0) included only 10 mL water swallows in the supine position [37]. However, many studies suggested that adjunctive tests could improve the diagnostic yield of HRM for the detection of motility disorders and for better defining the clinical relevance of these findings [38][39][40][41][42]. Furthermore, to ease the implementation of solid swallows in routine clinical practice, Hollenstein et al performed a development and validation study that aimed to define normal values of esophageal metrics for solid swallows.…”

Section: High-resolution Manometry and The Chicago Classification Version 40mentioning

confidence: 99%

Diagnosis and Management of Achalasia: Updates of the Last Two Years

Mari

Baker

Pellicano

et al. 2021

JCM

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Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.

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Diagnostic yield of adding solid food swallows during high‐resolution manometry in esophageal motility disorders

Cited by 12 publications

References 26 publications

Assessing the diagnostic yield of achalasia using provocative testing in high‐resolution esophageal manometry: Serial diagnostic study

Assessing the diagnostic yield of achalasia using provocative testing in high‐resolution esophageal manometry: Serial diagnostic study

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

Diagnosis and Management of Achalasia: Updates of the Last Two Years

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