Solid meal improves esophageal manometry testing for motility disorders

Last Updated: 2017-07-18

By Will Boggs MD

NEW YORK (Reuters Health) - Esophageal manometry with a solid test meal instead of single water swallows better diagnoses esophageal motility disorders, researchers from Switzerland and UK report.

High-resolution manometry is commonly used to assess esophageal motility, but motility present during single water swallows (SWS) may not reflect what happens in real life. Using a solid test meal (STM) might yield more clinically relevant results.

Dr. Mark Fox from University Hospital Zurich and colleagues report the results from two studies. In the first, they established reference limits for an STM and described the relationship between pharyngeal swallows, esophageal contractions, and speed of ingestion and states of health and disease.

Healthy volunteers required a median of 31 swallows and 14 effective contractions during the test meal. More than half of swallows (59%) were accompanied by failed or ineffective contractions that more often occurred within the first 60 seconds of starting the meal. Obstructive, spastic, or hypercontractile swallows were rare.

Patients with motility disorders ate about half as fast as healthy volunteers, and consumption of the STM reproduced their pathological esophageal motility, according to the July 3rd Lancet Gastroenterology and Hepatology online report.

Eating speed was associated only with frequency of swallows in healthy volunteers, whereas eating speed correlated with frequency of effective esophageal contractions in patients with dysphagia.

Overall, there was excellent agreement between HRM diagnosis based on SWS and STM, although some patients with achalasia on SWS had preserved contractility during STM, and only five of 12 patients with esophagogastric junction outlet obstruction on SWS had the diagnosis confirmed on STM.

In the second study, the researchers compared the diagnostic sensitivity of high-resolution manometry for major motility disorders using STM versus SWS in 750 patients, including 360 with dysphagia and 390 with reflux or other symptoms.

STM was significantly more sensitive than SWS for diagnosing major motility disorders in patients with dysphagia, reflux, or other symptoms.

The most common diagnosis established during STM that was not observed with SWS was esophagogastric junction outlet obstruction, and the most common change in diagnosis among patients with reflux symptoms was from ineffective esophageal motility based on SWS to normal findings based on STM.

All major motility disorders were more common with STM than with SWS, except absent peristalsis.

Patients with major motility disorders were more likely to report symptoms during STM (83%) than were those with minor motility disorders (70%) or those with normal motility (32%).

"These findings provide strong evidence that the inclusion of an STM in (high-resolution manometry) studies can increase both diagnostic sensitivity and specificity for clinically relevant, symptomatic motility disorders," the researchers conclude.

Dr. Philip O. Katz from Weill Cornell Medicine, New York, who coauthored an editorial related to this report, told Reuters Health by email, "The papers, for the first time in a large series, have demonstrated that eating a standardized solid test meal in the esophageal laboratory is not only feasible and appears to produce reliable tracings and results, but also appears to be clinically useful.”

“Most importantly, symptoms seem to be produced during the meal in many cases in association with manometric findings, not commonly seen with liquid or viscous swallows,” he said. “This is the most exciting part of the study; perhaps we will be able to definitively associate the presenting symptom with a motility abnormality, particularly non-achalasia motility abnormalities. If we can produce good outcome studies confirming this, manometry takes a major step forward.”

“At this point we have the opportunity to use these results to add on STM as an additional method of testing in the laboratory, augmenting our carefully studied and accepted methods of SWS,” Dr. Katz concluded.

Dr. Fox did not respond to a request for comments.

SOURCE: http://bit.ly/2uzaZHy, http://bit.ly/2tmMFcQ and http://bit.ly/2tlcC98

Lancet Gastroenterol Hepatol 2017.