Multiple Rapid Swallows (MRS) Complements Single-Swallow (SS) Analysis for High-Resolution Esophageal Manometry (HREM)

Leopold, Andrew R.; Yu, Daohai; Bhuta, Rajiv; Kataria, Rahul; Lu, Xiaoning; Jehangir, Asad; Harrison, Martha J.; Friedenberg, Frank K.; Malik, Zubair; Schey, Ron; Parkman, Henry P.

doi:10.1007/s10620-019-05545-2

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…The MRS has generally been utilized to assess for contractile reserve and was observed with a similar prevalence of contractile reserve in the present study compared with previous studies (70-80% of healthy controls). 9 , 30 Assessment of LES relaxation during MRS using the IRP may also be of clinical utility and the upper limit of normal of 12 mmHg reported in this study is the same as reported in another study. 30 The MRS has also been applied to assess contractile inhibition during MRS, observed, however in 20% of this asymptomatic cohort and 2/18 healthy controls (11%) in a previous study.…”

Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 78%

“…9,30 Assessment of LES relaxation during MRS using the IRP may also be of clinical utility and the upper limit of normal of 12 mmHg reported in this study is the same as reported in another study. 30 The MRS has also been applied to assess contractile inhibition during MRS, observed, however in 20% of this asymptomatic cohort and 2/18 healthy controls (11%) in a previous study. 31 The IRP garners particular attention given the importance placed on it as the initial decision point within the hierarchical Chicago classification scheme, primarily the 15 mmHg threshold when using supine 5 mL swallows with a Sierra-vintage HRM assembly.…”

Section: Discussionmentioning

confidence: 76%

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Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers

Krause

Masihi

et al. 2021

J Neurogastroenterol Motil

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Background/AimsIncorporation of complementary and provocative test swallows to the high-resolution manometry (HRM) protocol offers potential to address limitations posed by HRM protocols that involve only a single swallow type. The aim of this study is to describe normal findings of a comprehensive HRM testing protocol performed on healthy asymptomatic volunteers. MethodsThirty healthy asymptomatic volunteers completed HRM with 5-mL liquid swallows in the supine position. They also completed 5-mL liquid swallows in the upright position, viscous swallows, solid test swallows, multiple rapid swallows, and a rapid drink challenge. HRM studies were analyzed via Chicago classification version 3.0. ResultsThe median (5th-95th percentiles) for integrated relaxation pressure (IRP) on supine swallows was 11 (4-16) mmHg; IRP was lower than supine on upright liquid 9 (0-17) mmHg, viscous 6 (0-15) mmHg, solid 9 (1-19) mmHg, multiple rapid swallows 3 (0-12) mmHg, and rapid drink challenge 5 (-3-12) mmHg; P < 0.005. While an "elevated" IRP value was observed on 1 to 2 test maneuvers in 8/30 (27%) subjects, all 30 subjects had an IRP value < 12 mmHg on at least one of the test maneuvers. ConclusionsNormal values and findings from a comprehensive HRM testing protocol are reported based on evaluation of 30 healthy asymptomatic volunteers. Isolated "abnormalities" of IRP and contractile parameters were observed in the majority (80%) of these asymptomatic subjects, while all subjects also had normal features observed. Thus, the definition of "normal" should be recalibrated to focus on the entirety of the study and not individual metrics.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 76%

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Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers

Krause

Masihi

et al. 2021

J Neurogastroenterol Motil

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“…15 For each MRS manoeuvre, the time to complete the MRS, oesophageal body inhibition, mean IRP of the three MRS (MRS-IRP), and mean DCI of the three MRS (MRS-DCI) were assessed. 16 Oesophageal body inhibition was considered abnormal if there was a contraction segment with isobaric contour >20 mm Hg and >3 cm in length, 17 during the MRS course. Deglutitive inhibition of the LES was considered abnormal if the MRS-IRP was >15 mm Hg.…”

Section: High-resolution Manometry Analysismentioning

confidence: 99%

Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction

Visaggi

Ghisa

Corso

et al. 2022

Aliment Pharmacol Ther

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Summary Background Chicago classification version 4.0 (CCv4.0) introduced stringent diagnostic criteria for oesophagogastric junction outflow obstruction (EGJOO), in order to increase the clinical relevance of the diagnosis, although this has not yet been demonstrated. Aims To determine the prevalence of EGJOO using CCv4.0 criteria in patients with CCv3.0‐based EGJOO, and to assess if provocative manoeuvres can predict a conclusive CCv4.0 diagnosis of EGJOO. Methods Clinical presentation, high resolution manometry (HRM) with rapid drink challenge (RDC), and timed barium oesophagogram (TBE) data were extracted for patients diagnosed with EGJOO as per CCv3.0 between 2018 and 2020. Patients were then re‐classified according to CCv4.0 criteria, using clinically relevant symptoms (dysphagia and/or chest pain), and abnormal barium emptying at 5 min on TBE. Receiver operating characteristic (ROC) analyses identified HRM predictors of EGJOO. Results Of 2010 HRM studies, 144 (7.2%) fulfilled CCv3.0 criteria for EGJOO (median age 61 years, 56.9% female). Upon applying CCv4.0 criteria, EGJOO prevalence decreased to 1.2%. On ROC analysis, integrated relaxation pressure during RDC (RDC‐IRP) was a significant predictor of a conclusive EGJOO diagnosis by CCv4.0 criteria (area under the curve: 96.1%). The optimal RDC‐IRP threshold of 16.7 mm Hg had 87% sensitivity, 97.1% specificity, 95.7% negative predictive value and 91.3% positive predictive value for a conclusive EGJOO diagnosis; lower thresholds (10 mmHg, 12 mmHg) had better sensitivity but lower specificity. Conclusion CCv4.0 criteria reduced the prevalence of EGJOO by 80%, thereby refining the diagnosis and identifying clinically relevant outflow obstruction. Elevated RDC‐IRP can predict conclusive EGJOO per CCv4.0.

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“…In all studies evaluating normal MRS, the maneuver produced two physiological responses to multiple swallowing, a complete inhibition of esophageal body contraction during the maneuver accompanied by a complete relaxation of LES during the sequence and followed by an augmented contraction after completion. Leopold et al 32 performed a study to determine the relationship MRS responses and single liquid swallow responses in patients with esophageal motor disorders and healthy volunteers. In healthy volunteers, they described a 60% higher postdeglutitive DCI compared to single liquid swallow DCI.…”

Section: Resultsmentioning

confidence: 99%

Normative reference values for esophageal high‐resolution manometry in healthy adults: A systematic review

González

Nijhuis

Smout

et al. 2020

Neurogastroenterology Motil

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Esophageal manometry has been widely used to diagnose esophageal motility disorders. 1 It is the standard diagnostic tool in nonobstructive dysphagia, as it evaluates both pressures of the lower esophageal sphincter (LES) and contractility of the esophageal body. An important advancement in the last 20 years has been the introduction of high-resolution manometry (HRM), usually defined as manometry carried out with a catheter with at least 21 channels and with sensors at 1-cm intervals. 2 HRM is swiftly replacing conventional manometry, in which only a limited number of sensors (usually 4 to 8) are used. The generally perceived advantages of HRM over conventional manometry are that positioning of the catheter is less critical and that the interpretation of the recorded pressures, displayed in the form of topographical color-coded plots, is more intuitive. 3

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Multiple Rapid Swallows (MRS) Complements Single-Swallow (SS) Analysis for High-Resolution Esophageal Manometry (HREM)

Cited by 9 publications

References 13 publications

Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers

Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers

Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction

Normative reference values for esophageal high‐resolution manometry in healthy adults: A systematic review

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