* Inclusion of solid swallows and a test meal increase the diagnostic yield of high resolution manometry (HRM) in patients with dysphagia

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Gut

2011;60:A26

doi:10.1136/gut.2011.239301.52

Oral

Neuro-gastroenterology / motility section free papers

Inclusion of solid swallows and a test meal increase

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

dysphagia

http://gut.bmj.com/content/60/Suppl_1/A26.1.abstract?ct=ct

R Sweis *1,2,

A Anggiansah1,

R Anggiansah1,

J Fong1,

T Wong1,

M Fox1,3- Author Affiliations

1Gastroenterology, Guy's and St ' NHS

Foundation Trust, UK

2Nutritional Sciences, King's College London,

London, UK

3Nottingham Digestive Diseases Centre, Queen's

Medical Centre, Nottingham, UK

Abstract

Introduction

Standard manometry studies diagnose oesophageal dysmotility in patients

presenting with dysphagia on the basis of a small number of small

volume water swallows. The association of symptoms with abnormal

pressure events strongly support the clinical relevance of manometry

findings; however, patients report symptoms infrequently with 5–10 ml

water swallows. Solid swallows and normal eating behaviour have not

entered clinical practice because of the difficulty interpreting the

complex pressure events and a lack of control values. The aim of this

study was to assess the prevalence of symptomatic oesophageal

dysfunction following individual liquid and solid bolus swallows and a

standardised test meal in patients presenting with dysphagia and

asymptomatic volunteers

Methods 30

consecutive patients referred for investigation of endoscopy negative

dysphagia 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 and for 10 healthy volunteers

Results

Water and bread swallows were successful in 29/30 patients (12 M:18 F,

age 16–86) and all healthy volunteers (11 M:12 F, age 20–56). 10

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

had clinically significant dysmotility or complained of symptoms. 2/29

(7%) patients experienced their typical symptoms with water, 13/29 (45%)

with bread (p = 0.023), 8/10 (80%) with the meal and 16/29 (55%) when

results of bread and meal were combined (p = 0.008 compared to water

swallows).

A change in HRM diagnosis

was made in 8/29 (28%) patients on the basis of solid compared to water

swallows, of whom 5 (17%)

complained of typical symptoms. When

a meal was provided, there was a change in HRM findings in 7/10

patients compared to

5 ml water, of whom 4 complained of

typical symptoms. When results were combined 10/29 (35%) showed a change

in diagnosis

and 5 had typical symptoms.

Pathology that would have

been missed with water swallows alone included: hypertensive

contractility (2), spasm (2), variant

achalasia (1) and increased

resistance to flow at the gastro-oesophageal junction (3). The clinical

relevance of 5/8 (62.5%)

of these was confirmed with typical

symptoms coincident with abnormal pressure events. Two patients with

asymptomatic hypotensive

dysmotility with water showed

normalisation with solid swallows

Conclusion

The diagnostic yield and ability to associate symptoms with oesophageal

dysfunction is increased with inclusion of solid

swallows and a test meal compared to

water swallows alone in patients with endoscopy-negative dysphagia

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