diagnostic yield of high resolution manometry

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Gut

2011;60:A165-A166

doi:10.1136/gut.2011.239301.351

Posters

Neurogastroenterology/motility

Inclusion of solid swallows and a test meal increase

the diagnostic yield of high resolution manometry (HRM) in patients with

reflux symptoms

http://gut.bmj.com/content/60/Suppl_1/A165.2.abstract?ct=ct

R Sweis *1,2,

A Anggiansah1,

R Anggiansah1,

J Fong1,

T Wong1,

M Fox1,3+ Author Affiliations

1Gastroenterology, Guy's & St NHS

Foundation Trust, London, UK

2Nutritional Sciences, King's College London,

London, UK

3Nottingham Digestive Diseases Centre, Queen's

Medical Centre, Nottingham, UK

Abstract

Introduction

Manometry is applied in patients with suspected gastro-oesophageal

reflux disease (GORD) to exclude motility disorders as

a cause of symptoms. Routine studies

use a small number of small volume water swallows, however dysmotility

and symptoms are

more likely to occur with normal

eating behaviour. This approach has not entered clinical practice

because of difficulty interpreting

complex pressure events during

ingestion of solids and a standardised meal as well as a lack of control

values. This study

aimed to assess the prevalence of

symptomatic oesophageal dysfunction following individual liquid and

solid bolus swallows

and a standardised meal in patients

with reflux symptoms and asymptomatic volunteers.

Methods 45

consecutive patients with predominant reflux symptoms and 23 healthy

volunteers underwent HRM (Manoscan 360°, SSI) with

10×5 ml water and 5×1 cc bread

swallows in the upright seated position. A test meal (cheese and onion

pie; 500 kcal, 34 g

fat) was provided if patients

consented. Ambulatory reflux studies were performed in patients.

Results

Water and bread swallows were completed in 44/45 patients (16 M:28 F,

age 32–76) and all healthy volunteers (11 M:12 F, age 20–56). 18

patients and 10 volunteers completed the test meal. No healthy subject

had clinically significant dysmotility or symptoms during the study.

There were no symptoms with water swallows. 14/44 (32%) complained of

symptoms with bread (p =0.0013), 7/18 during the meal and 16/44 (36%)

when results of bread and meal were combined (p=0.0006). Bread swallows

and a test meal resulted in a change of manometry diagnosis in 18/44

(41%) patients. In 13 patients dysmotility was present with solid but

not water swallows: hypertensive contractility (3), oesophageal spasm

(4), resistance at the gastro-oesophageal junction (4), variant

achalasia (1) and severe peristaltic dysfunction (1). Conversely, normal

peristalsis was seen in 5 asymptomatic patients with hypotensive

motility on water swallows. Symptoms were associated with oesophageal

dysfunction during the test meal in 7/16 (44%) patients: hypertensive

contractility (1), oesophageal spasm (3), and resistance at the

gastro-oesophageal junction (3).

Ambulatory reflux studies

were completed in 40/45 patients and 18/40 (45%) patients had an

objective diagnosis of GORD. A

new diagnoses based on symptomatic

dysmotility was present in 1/18 (6%) patients with GORD, and 6/22 (27%)

patients without

GORD (p=0.016).

Conclusion

The inclusion of solid swallows and a test meal increased the

diagnostic yield of HRM in patients referred for investigation

of reflux symptoms compared to

standard water swallows, in particular, in the patient group without

GORD on reflux studies.

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