W1803 High Resolution Manometry with Large Volume Multiple Repeated Swallows AIDS the Detection of Oesophageal Pathology

Abstract

Conventional manometry does not provide a diagnosis in many patients referred with esophageal symptoms because, in part, it fails to predict effective bolus transport.[1,2] High resolution manometry (HRM) measures contractile activity and the intra-bolus pressure (IBP) gradient that drives fluidmovement.[3] In the pharynx, the position of maximum IBP gradient following 10-20ml swallows identifies pathology causing clinically significant resistance to flow.[4] A similar approach with larger volumes has not been tested in the relatively wide lumen of the esophagus. AIMS & METHODS: To assess whether HRM during multiple repeated swallows of water (MRS) can help identify esophageal pathology and quantify functional and structural resistance to flow in the esophageal body and lower esophageal sphincter (LES). A prospective study of 160 consecutive patients undergoing investigation of esophageal symptoms was performed. HRM for ten water (10ml) and five bread swallows were obtained in the upright position. Peristaltic pressure, baseline and nadir LES pressure, IBP, and IBP gradient were recorded. Patients then drank 200ml water by MRS. Symptom events were recorded. RESULTS: 125 studies provided complete data for analysis (78%). Failed swallows (p 20mmHg (p<0.01 vs. lower values). CONCLUSION: HRM with 200ml MRS is a simple, physiological test that helps to localize and quantify the severity of esophageal pathology by increasing IBP above and IBP gradient across the lesion compared to 10ml water swallows. Functional and structural disease were identified by this technique. In addition, raised IBP during MRS was associated with the occurrance of typical, clinically relevant symptoms. REFERENCE(S): 1.Fox NGM 04, 2.Tutuian AJG 04, 3.Pandolfino AJP 06., 4.Pal AJP 03