Use of Solid Boluses in High-resolution Manometry

Abstract

We read with great interest the data presented by Zhang et al1 regarding changes in high-resolution manometry (HRM) values when the procedure was performed in the upright position using solid swallows. Dysphagia and other esophageal symptoms due to abnormal esophageal motility have been shown to be poorly diagnosed by clinical history or endoscopy.2,3 Assessment of esophageal manometry is advocated as the subsequent investigation. While HRM based on standard supine water swallows as described by the Chicago classification4 has been effective in guiding the management of achalasia, it has had limited impact on clinical management of other motility disorders.5 In addition, it is increasingly recognized that performing HRM in a supine position is non-physiological and poorly tolerated by some patients. Performing the investigation in an upright position results in changes in the normative values which may alter the diagnosis in some patients.6 In addition, the use of solid swallows as a provocative physiological test has been shown to increase the sensitivity of detecting motility disorders7 and has been advocated as a complementary test to the standard water swallows.8,9