Multiple rapid swallowing: a complementary test during standard oesophageal manometry

Abstract

Multiple rapid swallowing (MRS) stimulates neural inhibition resulting in abolition of contractions in the oesophageal body (OB) and complete lower oesophageal sphincter (LOS) relaxation which is followed by peristalsis and LOS contraction. The aim of this study was to evaluate the yield of MRS to detect abnormalities in inhibitory or excitatory oesophageal mechanisms in patients with oesophageal symptoms and either normal standard manometry or ineffective oesophageal motility (IOM). MRS (five water swallows, 2 mL, separated by 2-3 s) was evaluated in 23 healthy subjects, 109 symptomatic patients with normal standard sleeve manometry and in 48 patients with IOM. Healthy subjects had complete inhibition of OB motility during MRS and a strong motor response after MRS, i.e. amplitude of OB contractions in the oesophageal body and LOS tone being higher than after single swallows. Almost 70% of patients with oesophageal symptoms and normal manometry had abnormal MRS, mainly consistent on inability to increase amplitude of OB contractions after MRS. Nearly, half of the patients with IOM were able to normalize OB contractions after MRS. MRS is a simple complementary test that can be added to standard oesophageal manometry. Two-thirds of patients with normal manometry show abnormal MRS that could potentially underlie their symptoms. A normal response to MRS in patients with severe IOM might be used to predict response to prokinetic treatment.

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

“…4). Conversely, in other instances, diagnosis might be achieved via minimal bolus flow time ascertained during high-resolution impedance mano metry 28,29 , a timed barium oesophagram 26 , or a rapid drink challenge 30,31 . However, in most cases an IRP >15 mmHg will suffice to detect impaired EGJ relaxation.…”

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

“…We adopted the MRS test because it is cheap and easy-to-execute and to interpret, allowing a widespread utilization as a complementary test during HRM. 17 Overall, we consider the current MRS test Finally, a study performed by means of magnetic resonance showed that reflux volume is higher than 5-10 mL of water administered during a standard HRM protocol study. 39 For this reason, the esophageal contraction after a multiple rapid sequence of swallows may better represent the motor contraction elicited after a gastro-esophageal reflux event.…”

Achalasia: It Is Not All Black and White

“…With multiple rapid swallows (MRS), five 2 ml water swallows are administered 2-3 s apart [30,31], while with multiple water swallows (MWS), 200 ml of water is drunk freely [26•, 32]. The response to both tests in normal individuals is augmentation of deglutitive inhibition leading to complete LES relaxation and termination of peristalsis in the esophageal body.…”