Rapid drink challenge test during esophageal high resolution manometry in patients with esophago‐gastric junction outflow obstruction

Abstract

Pan-esophageal pressurization and esophageal shortening were associated with symptoms severity but did not predict the cause of this disorder. Further prospective studies are necessary to determine if RDC test could help to select patients who might benefit from treatment.

Rapid drink challenge test for the clinical evaluation of patients with Achalasia

“…Different groups have shown the potential of this test to discriminate patients with obstruction across the EGJ. In patients with dysphagia after fundoplication, outlet obstruction across the esophagogastric junction was detected more commonly during the 200‐ml RDC than during single swallows, an altered IRP during the RDC discriminates healthy controls from patients with EGJ dysfunction of different origin, and esophageal shortening and panesophageal pressurization during the RDC test are common findings in patients with EGJ outflow obstruction . In a recent study from our group, we have described that the RDC produces specific patterns of pressure responses in patients with specific motor disorders .…”

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

“…RDC performs much less efficiently in demonstrating contraction reserve, presumably because of the prolonged inhibitory stimulus of high volume drinking . Instead, RDC is a better test for demonstration of EGJ obstruction, which can correlate with severity of dysphagia …”

“…Instead,RDC is a better test for demonstration of EGJ obstruction, 52 which can correlate with severity of dysphagia 48,49,52,53. As patients often report esophageal symptoms in relationship to meals, viscous or solid swallows,54,55 test meals, 57,58 RDC,48,49,51 and postprandial monitoring60,61 have been utilized to provoke symptoms during manometry and to identify EGJ outflow obstruction…”

Esophageal provocation tests: Are they useful to improve diagnostic yield of high resolution manometry?

“…Normative values from two sizable cohorts were recently reported, and an IRP during RDC of ≥12 mm Hg (using a Sierra‐vintage HRM assembly) was proposed as a useful threshold to identify EGJ dysfunction associated with achalasia, and ≥8 mm Hg to identify “all cause” EGJ outflow obstruction . In addition, presence of pan‐esophageal pressurization during the RDC test may be indicative of achalasia and EGJ outflow obstruction . Esophageal clearance of the 200 cc liquid (when impedance‐manometry is utilized) can also be assessed and while monitoring of the post‐swallow response for 30 seconds is often reported, monitoring for up to five minutes also allows measurement of an impedance bolus height, a measure similar to a barium column height on a timed‐barium esophagram …”

“…34,35 In addition, presence of panesophageal pressurization during the RDC test may be indicative of achalasia and EGJ outflow obstruction. 34,36 Esophageal clearance of the 200 cc liquid (when impedance-manometry is utilized) can also be assessed and while monitoring of the post-swallow response for 30 seconds is often reported, 32,34,35,37 monitoring for up to five minutes also allows measurement of an impedance bolus height, a measure similar to a barium column height on a timed-barium esophagram. 38…”