Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high‐resolution manometry

Sweis, Rami; Anggiansah, Angela; Wong, Terry; Brady, Ged; Fox, Mark

doi:10.1111/nmo.12252

Cited by 86 publications

(135 citation statements)

References 44 publications

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“…To increase the specificity of an elevated IRP with preserved peristalsis for the diagnosis of EGJOO, provocative maneuvers or adjunctive studies, such as a rapid drink challenge or solid test meal, can be applied 50,31 .…”

Section: Achalasia With Preserved Peristalsismentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Achalasia With Preserved Peristalsismentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…Unlike what occurs after the RS test, the absence of a final peristaltic wave after the stress test with MS does not appear to be relevant (it does not show up in 50% of normal controls) (40,41,94).…”

Section: Current Situationmentioning

confidence: 91%

“…However, advantages have been identified in certain situations with the patient sitting (39) and using a solid bolus or standardized food (40)(41)(42). Although some studies have been published with reference values under these conditions (43,44), such conditions are not common and are not covered by the CCH, which is most commonly used to define esophageal motor disorders (3,31).…”

Section: Current Situationmentioning

confidence: 99%

See 1 more Smart Citation

Practical aspects of high resolution esophageal manometry

Juan¹,

Ríos²,

Bueno³

et al. 2016

Rev Esp Enferm Dig

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High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.

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“…A key insight from this work is that dysphagia and other symptoms are rarely caused by abnormal motility unless it is accompanied by impaired function such as bolus retention or reflux [11,12]. This approach has been applied to assess oesophageal function during 'rapid drink challenge' and eating a solid test meal (STM) [13][14][15]. In serial diagnostic studies, this approach increased the diagnostic yield of HRM for major oesophageal motility disorders.…”

Section: Question 1: What Are the Most Frequent Reasons Or Indicationmentioning

confidence: 99%

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

et al. 2018

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Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high‐resolution manometry

Cited by 86 publications

References 44 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Practical aspects of high resolution esophageal manometry

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

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