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Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry
- Publication Year :
- 2020
- Publisher :
- Wiley-Blackwell, 2020.
-
Abstract
- Background Standard high-resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position. Aims To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders. Methods Seventy-two healthy volunteers (20-76 years) and 366 consecutive patients (18-90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests. Results Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = 0.0007). Similarly, the difference in concordance for the diagnosis of oesophago-gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = 0.0087). Conclusion Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.
- Subjects :
- Adult
Male
Supine position
Adolescent
Manometry
Posture
Achalasia
610 Medicine & health
Oesophageal motility
03 medical and health sciences
Young Adult
0302 clinical medicine
Swallowing
Reference Values
medicine
Supine Position
Humans
2736 Pharmacology (medical)
Pharmacology (medical)
Esophageal Motility Disorders
2715 Gastroenterology
030212 general & internal medicine
Prospective Studies
Prospective cohort study
High resolution manometry
Aged
Aged, 80 and over
Hepatology
business.industry
Diagnostic Tests, Routine
digestive, oral, and skin physiology
Gastroenterology
Middle Aged
medicine.disease
Deglutition
Position (obstetrics)
Diagnostic Techniques, Digestive System
10219 Clinic for Gastroenterology and Hepatology
Anesthesia
Reference values
030211 gastroenterology & hepatology
Female
2721 Hepatology
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....b298c7fdb3f95c3d0d983a26200b3681
- Full Text :
- https://doi.org/10.7892/boris.149318