M1147 Multiple Rapid Swallowing Testing in Patients With Esophageal Symptoms: A Study Using High-Resolution Manometry

Patuto, Nicola; Pohl, Daniel; Castell, Donald O.; Tutuian, Radu

doi:10.1016/s0016-5085(10)61573-9

Cited by 1 publication

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Section: Introductionmentioning

confidence: 99%

“…Basic and clinical studies have demonstrated MRS to be a powerful tool for investigating neural pathways in the human esophagus, and may help to further classify esophageal motility disorders. 16,17,20 We hypothesize that various achalasia subtypes will demonstrate distinctive MRS responses, which might provide clues to pathophysiologic mechanisms underlying each subtype. To test this hypothesis, this study identified consecutive subjects with achalasia spectrum disorders with an adequately performed MRS maneuver, and compared responses among the subtypes.…”

Section: Introductionmentioning

confidence: 99%

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Multiple rapid swallow responses segregate achalasia subtypes on high‐resolution manometry

Kushnir

Sayuk

Gyawali

2012

Neurogastroenterology Motil

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Background Multiple rapid swallows (MRS) inhibit esophageal peristalsis and lower esophageal sphincter (LES) tone; a rebound excitatory response then results in an exaggerated peristaltic sequence. MRS responses are dependent on intact inhibitory and excitatory neural function and could vary by subtype in achalasia spectrum disorders. Methods Consecutive subjects with incomplete LES relaxation on HRM (Sierra Scientific, Los Angeles, CA) in the absence of mechanical obstruction were prospectively identified. Achalasia spectrum disorders were classified and HRM plots reviewed according to Chicago criteria. Esophageal peristaltic performance and LES function were assessed after 10 wet swallows and MRS (five 2 mL water swallows 2-3 s apart). Findings were compared to 18 healthy controls (28.5±0.6 years, 44% female). Results 46 subjects (57.1±2.1 years, 52.2% female) met inclusion criteria. There was complete failure of peristalsis with MRS in all subjects with achalasia subtypes 1 and 2. In contrast, 80% of achalasia subtype 3 and incomplete LES relaxation (EGJ outflow obstruction) with preserved esophageal body peristalsis had a contractile response to MRS (p<0.001 compared to subtypes 1 and 2); controls demonstrated 94.4% peristalsis. Percent MRS decrease in LES residual pressure compared to wet swallows segregated achalasia subtypes; those with aperistalsis (subtypes 1 and 2) had a lesser decline (22.6%) compared to those with retained esophageal body peristalsis (40.5%) and controls (51.3%, p<0.001 across groups). Conclusion MRS responses segregate achalasia spectrum disorders into two patterns differentiated by presence or absence of esophageal body contraction response to wet swallows. These findings support subtyping of achalasia, with pathophysiologic implications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%