Editorial: upright manometry—a lot more to swallow

Katzka, David A.; Kahrilas, Peter J.

doi:10.1111/apt.15690

Cited by 1 publication

(1 citation statement)

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“…Although there was no significant difference in the degree of patient’s comfort during HRM, both the semirecumbent and the sitting position simulate more closely a real-life behavior and allow to safely perform some provocative maneuvers. It has previously been suggested that HRM should preferably be performed in the sitting position, especially in patients with swallowing difficulties and risk of aspiration, and that adjunctive maneuvers, such as the rapid drink challenge, should be added to resolve diagnostic discrepancies and improve overall accuracy [14]. Moreover, two previous studies, one in GERD patients [15] and one in normal volunteers [16] have reported the use of the semirecumbent position during HRM.…”

Section: Discussionmentioning

confidence: 99%

The semirecumbent position for high-resolution esophageal manometry. Results of a feasibility study

Siboni

Riva²,

Ferrari³

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Objective Normative values for high-resolution manometry (HRM) have been obtained with the patient lying supine. The aim of the study was to compare supine, semirecumbent and sitting positions during HRM in terms of variation in normative metrics, diagnostic yield, and patient’s comfort. Methods A prospective, single-center feasibility study was planned in consecutive patients referred to the esophageal function laboratory. In each of the three positions, 10 consecutive 5 ml water swallows and three 10 ml multiple rapid swallows were administered. Validated reflux questionnaires were administered prior to the test, and a visual analogue scale (VAS) assessing the patient’s comfort after the test. Results Twenty patients presenting with gastroesophageal reflux symptoms completed the study protocol. The intra-abdominal segment of the lower esophageal sphincter was significantly longer in the sitting position (P = 0.013), and the multiple rapid swallow distal contractile integral was lowest in the supine position (P = 0.012). The VAS comfort score did not significantly differ in the three body positions (P = 0.295). The concordance in the final diagnosis was 80% for semirecumbent vs. sitting (kappa = 0.15; P = 0.001), 70% for supine vs. sitting and 65.0% for semirecumbent vs. supine. Conclusion Compared to the supine position, both the semirecumbent and sitting position seems to provide similar advantages. HRM metrics and the final manometric diagnosis may be affected by body position, but complementary maneuvers, such are the rapid drink challenge, can resolve diagnostic discrepancies and improve the overall accuracy of the test.

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Section: Discussionmentioning

confidence: 99%