200 mL Rapid Drink Challenge During High-resolution Manometry Best Predicts Objective Esophagogastric Junction Obstruction and Correlates With Symptom Severity

Philip Woodland; Shirley Gabieta-Sonmez; Julieta Arguero; Joanne Ooi; Kenichiro Nakagawa; Esteban Glasinovic; Etsuro Yazaki; Daniel Sifrim

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저자정보: Philip Woodland (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Shirley Gabieta-Sonmez (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Julieta Arguero (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Joanne Ooi (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Kenichiro Nakagawa (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Esteban Glasinovic (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Etsuro Yazaki (Barts and the London School of Medicine and Dentistry Queen Mary University of London London UK) Daniel Sifrim (Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK)

저널정보: 대한소화관운동학회(현 대한소화기능성질환.운동학회) Journal of Neurogastroenterology and Motility (JNM) Journal of Neurogastroenterology and Motility (JNM) Vol.24 No.3

발행연도: 2018.1

수록면: 410 - 414 (5page)

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Background/Aims Single swallow integrated relaxation pressure (IRP) on high-resolution manometry (HRM) does not always accurately predict esophagogastric outflow obstruction on timed barium esophagogram (TBE). Furthermore, neither single swallow IRP or TBE is reliable in predicting symptoms, particularly after treatment with dilatation or myotomy. A 200 mL rapid drink challenge (RDC) has been proposed as an adjunctive test during HRM. This serves as a “stress-test” to the esophagogastric junction, and may yield clinically useful parameters. We aim to assess HRM parameters during RDC, and their ability to predict outflow obstruction on TBE in patients with dysphagia, and to correlate with symptoms in patients’ achalasia. Methods Thirty patients with dysphagia were recruited. All underwent standard single swallow HRM analysis, 200 mL RDC, then TBE. RDC parameters, including esophagogastric pressure gradient, IRP, and RDC duration were evaluated. Multiple regression analysis was performed to assess the best predictive parameter for obstruction on TBE. A further 21 patients with achalasia were evaluated with Eckhardt score, single swallow HRM, RDC, and TBE. Parameter correlation with Eckhardt score was evaluated. Results Mean IRP during RDC was the best HRM parameter at predicting outflow obstruction on TBE. This performed much better in untreated patients (sensitivity 100% and specificity 85.5%) than in previously treated patients (sensitivity 50% and specificity 66%). In patients with achalasia, mean IRP during RDC was the only parameter that correlated with symptom score. Conclusion Mean IRP during RDC appears to be a clinically useful “stress test” to the esophagogastric junction during HRM.

참고문헌 (11)

참고문헌 신청

Kahrilas PJ / 2015 / The Chicago Classification of esophageal motility disorders, v3.0 / Neurogastroenterol Motil 27:160~174

Xiao Y / 2014 / Lack of correlation between HRM metrics and symptoms during the manometric protocol / Am J Gastroenterol 109:521~526

Lin Z / 2015 / High-resolution impedance manometry measurement of bolus flow time in achalasia and its correlation with dysphagia / Neurogastroenterol Motil 27:1232~1238

Kwiatek MA / 2010 / Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP) / Gastrointestinal endoscopy 72:272~278

Vaezi MF / 2002 / Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment / Gut 50:765~770

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