Water Swallows Versus Food Ingestion as Manometric Tests for Esophageal Dysfunction

Allen, Melvin L.; Orr, William C.; Mellow, Mark H.; Robinson, Malcolm

doi:10.1016/s0016-5085(88)80036-2

Cited by 40 publications

(31 citation statements)

References 9 publications

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“…The current report extends previous observations that esophageal motor abnormalities were seen more frequently in patients during the test meal than they were with water swallows [5,6,12]. Of clinical importance is the finding that a swallow of a substance with a higher consistency than water acts as a power stressor and elicits more abnormal contractions in patients with dysphagia.…”

Section: Discussionsupporting

confidence: 85%

“…Final manometric diagnosis, based on previously published manometric criteria, was as follows: NEMD, achalasia, DES, nutcracker esophagus, and normal [7][8][9][10]. The criteria for motor abnormalities after solid ingestion were based on our previous data and established criteria [3,6,25] …”

Section: Esophageal Motilitymentioning

confidence: 99%

“…Among these, NEMD was the most common motility disturbance affecting 39% of these patients evaluated with esophageal manometry [3,4]. Furthermore, studies have demonstrated that esophageal motor abnormalities are seen more frequently during food ingestion compared with water swallows [5,6]. It was concluded that a bolus with a greater consistency than water is useful in detecting abnormal esophageal motility in patients with dysphagia.…”

mentioning

confidence: 99%

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Comparison of Esophageal Motility in Patients with Solid Dysphagia and Mixed Dysphagia

Chen

Orr

2005

Dysphagia

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It is unclear whether there is any difference in esophageal motor abnormalities between patients complaining of dysphagia for solids or both solids and liquids. The aim of this study was to determine any difference in the manometric findings between patients with dysphagia for solids and those with mixed dysphagia. Manometric tracings were performed in 200 consecutive patients (66 M, 134 F; mean age = 51 years) with nonobstructive dysphagia. Ambulatory pH studies were performed in all patients. Subjects were divided into two groups: patients with solid dysphagia (n = 94, 33 M, 61 F; mean age = 51 years) and those with mixed dysphagia (n = 106, 33 M, 73 F; mean age = 51 years). A normal motility study was the most frequent finding. Achalasia occurred more frequently in patients with mixed dysphagia than in those with solid dysphagia (12% vs. 3%, p < 0.01). Gastroesophageal reflux disease (GERD) was observed in 59% of patients with solid dysphagia compared with 29% of patients with mixed dysphagia (p < 0.02). The most common esophageal motility abnormality is nonspecific esophageal motility disorders. This study has shown that abnormal esophageal motility occurs slightly more in mixed dysphagia than solid dysphagia. The clinical utility of a symptomatic differentiation of patients with solid or mixed dysphagia appears to be limited.

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Section: Discussionsupporting

confidence: 85%

Section: Esophageal Motilitymentioning

confidence: 99%

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confidence: 99%

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Comparison of Esophageal Motility in Patients with Solid Dysphagia and Mixed Dysphagia

Chen

Orr

2005

Dysphagia

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“…These tests include food ingestion [83], intraesophageal balloon distention [84][85][86], pentagastrin [87,88], vasopressin [89], ergonovine [90][91][92][93], bethanechol [94][95][96][97][98], and edrophonium [86,93,95,[99][100][101][102]. Edrophonium has become the most popular because it is both useful and safe.…”

Section: Noncardiac Chest Painmentioning

confidence: 99%

“…Despite the relatively higher diagnostic yield of esophageal motility testing in demonstrating a motor disorder in patients with dysphagia compared with noncardiac chest pain and gastroesophageal reflux patients, provocative tests have increased the sensitivity of standard water-swallow testing. Food ingestion has been shown to significantly increase the identification of a motor disorder in dysphagia patients with normal water-swallow testing [83,[121][122][123][124].…”

Section: Dysphagiamentioning

confidence: 99%

Clinical Value of Esophageal Motility Testing

DiMarino

Allen²,

Lynn³

et al. 1998

Dig Dis

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Esophageal motility testing is the method of choice in evaluating esophageal motor disorders. Some physicians, however, question the clinical utility of esophageal motility testing, since the results are often normal in symptomatic patients. The clinical utility of esophageal motility testing is reviewed for patients with a complaint of noncardiac chest pain, dysphagia or symptoms of gastroesophageal reflux disease. Esophageal motility testing is particularly useful for evaluating patients with dysphagia, but less so for gastroesophageal reflux disease patients, and has little clinical utility in patients with noncardiac chest pain.

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Unexplained dysphagia: Viscous swallow-induced esophageal dysmotility

Meshkinpour

Eckerling

1996

Dysphagia

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Dysphagia is a manifestation of several clinical conditions of diverse origin. In spite of the variation in these disease entities in terms of their etiology, clinical presentation, natural history, and treatment, the mechanism of this clinical complaint is not always clear. We studied a group of patients with dysphagia for solids in whom no anatomic or motor abnormalities were encountered on standard studies. The group consisted of 37 patients, 25 women and 12 men, who were complaining of dysphagia of 6 months or longer duration and they did not demonstrate structural or motor abnormalities on barium esophagogram, esophagoscopy, and standard esophageal manometry. A group of 24 age-matched patients, 14 women and 10 men, with noncardiac chest pain served as the patient control. Esophageal contractile activities were studied after 10 wet swallows (5 ml of water) and 10 viscous swallows (5 cubic cm of marshmallow). Resting lower esophageal sphincter pressure and its relaxation response to swallows, amplitude of peristaltic activities, rate of dysphagia provoked during the study, and the frequency of abnormal esophageal contractions were evaluated. Six abnormal esophageal contractile activities-failed peristalsis, dropout, repetitive, simultaneous, spontaneous contractions, and aperistalsis-were utilized to generate an esophageal peristaltic dysfunction index. The mean LESP was 8.1 +/- 4.7 in the dysphagia group and 16.1 +/- 4.3 in the chest pain group. The mean amplitude of peristaltic contractions was 47.1 +/- 16.1 and 89.0 +/- 27.0 mmHg after wet swallows for dysphagia and chest pain groups, respectively. These values were 58.2 +/- 12.4 and 92.4 +/- 22.1 for viscous swallows. Swallowing provoked dysphagia in 89% of the dysphagia group after viscous swallows and 9% after wet swallows. In contrast, only 11% and 3% of control group complained of dysphagia during the study. This group of patients probably represent a cohort of patients with a nonspecific esophageal motor disorder in whom both clinical symptom and their esophageal motor counterpart can only be elicited in response to viscous swallows. We strongly believe in addition of viscous swallows in evaluating dysphagic patients in whom symptoms remain unexplained in light of standard studies.

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Water Swallows Versus Food Ingestion as Manometric Tests for Esophageal Dysfunction

Cited by 40 publications

References 9 publications

Comparison of Esophageal Motility in Patients with Solid Dysphagia and Mixed Dysphagia

Comparison of Esophageal Motility in Patients with Solid Dysphagia and Mixed Dysphagia

Clinical Value of Esophageal Motility Testing

Unexplained dysphagia: Viscous swallow-induced esophageal dysmotility

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