The differences in the esophageal motility between liquid and solid bolus swallows: A multicenter high‐resolution manometry study in Chinese asymptomatic volunteers

Abstract

Background The results of the esophageal body motility differences between liquid and solid swallows from high‐resolution manometry (HRM) studies are not consistent. The information of the frequency of ineffective liquid and solid bolus swallows in healthy individuals during HRM procedure is limited. The normative values of the HRM parameters of both liquid and solid swallows for Chinese population are lacking. Methods The esophageal HRM data of 101 healthy volunteers from multicenters in China were analyzed. The values of the HRM parameters were summarized and compared between liquid and solid swallows. The frequencies of ineffective liquid and solid swallows were summarized. Results Esophagus contracted stronger and slower in solid bolus swallows than water swallows with HREM. Ineffective water swallow (DCI < 450 mm Hg.s.cm) and ineffective bread swallow (DCI < 800 mm Hg.s.cm) were frequently seen in asymptomatic individuals. The adding of bread swallows to the HREM procedure might cause diagnostic change in about 15.8% (16/101) of the asymptomatic individuals. Conclusions The vigor and velocity of the esophageal peristalsis between liquid and solid bolus swallows are different. Ineffective water and solid bolus swallows are not rare. Adding solid bolus swallows brings diagnostic change, and it may be needed routinely for the HRM procedure.

Normative reference values for esophageal high‐resolution manometry in healthy adults: A systematic review

“…They report an increase in IRP for solids boluses compared to liquids swallows; they attributed this finding to an increased friction between the bolus and the luminal wall, and not to LES dysfunction. These results contrast with more recent studies performed by Zhang et al, 25 Xiang et al 18 and Wong et al, 29 since they all report a lower threshold for IRP during solid boluses compared to water swallows. In all studies evaluating solid bolus consistency swallows, DCI 95th percentile values were higher than DCI values for liquid swallows.…”

“…A total of twelve studies described normative values with differ- they attributed this finding to an increased friction between the bolus and the luminal wall, and not to LES dysfunction. These results contrast with more recent studies performed by Zhang et al, 25 Xiang et al 18 and Wong et al, 29…”

Proximal esophageal contraction after induction of ineffective distal contraction by sildenafil in healthy volunteers

“…These results suggest that the proximal esophageal response to the decrease of distal contraction is mediated by esophageal sensitivity. As previously demonstrated, solid bolus swallow caused more ineffective contractions than liquid bolus [25].…”

Updates on diagnostic modalities for esophageal dysphagia

“…29 Moreover, the use of applesauce and/or marshmallow swallows in the supine position led to an alternative diagnosis in 18% of patients compared with liquid swallows alone, with the majority (11/14 patients) receiving a new diagnosis of EGJOO. 30 Solid swallows were also found to add diagnostic yield in patients presenting with postfundoplication dysphagia. 31 A number of studies have sought to compare manometric parameters, landmarks, and measurements obtained through the standard liquid swallows in the traditional supine position and metrics obtained through viscous or solid swallows in the upright position among healthy volunteers.…”

“…Viscous and solid swallows were found to be associated with a higher IRP, longer EGJ relaxation duration, shorter transition zone, slower contractile front velocity, more vigorous DCI, and higher intrabolus pressure. 30,[32][33][34] Different sets of normative values have also been developed for solid swallows in both upright and supine positions from these studies of healthy controls. 32 Despite the increased diagnostic yield of abnormal motility pattern with viscous or solid swallows, the correlation between these findings and either BT or clinical symptoms remains conflicted.…”