Influence of bolus consistency and position on esophageal high-resolution manometry findings.
BACKGROUND
Conventional esophageal manometry evaluating liquid swallows in the recumbent position measures pressure changes at a limited number of sites and does not assess motility during solid swallows in the physiologic upright position.


OBJECTIVE
To evaluate esophageal motility abnormalities during water and bread swallows in the upright and recumbent positions using high-resolution manometry (HRM).


METHODS
Thirty-two-channel HRM testing was performed using water (10 ml each) and bread swallows in the upright and recumbent positions. The swallows were considered normal if the distal peristaltic segment >30 mmHg was >5 cm, ineffective if the 30-mmHg pressure band was <5 cm, and simultaneous if the onset velocity of the 30 mmHg pressure band was >8 cm/s. Abnormal esophageal manometry was defined as the presence of > or =30% ineffective and/or > or =20% simultaneous contractions.


RESULTS
The data from 96 patients (48 F; mean age 51 years, range 17-79) evaluated for dysphagia (56%), chest pain (22%), and gastroesophageal reflux disease (GERD) symptoms (22%) were reviewed. During recumbent water swallows, patients with dysphagia, chest pain, and GERD had a similar prevalence of motility abnormalities. During upright bread swallows, motility abnormalities were more frequent (p = 0.01) in patients with chest pain (71%) and GERD (67%) compared to patients with dysphagia (37%).


CONCLUSIONS
Evaluating bread swallows in the upright position reveals differences in motility abnormalities overlooked by liquid swallows alone.
Bernhard
Anita
A
Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
Pohl
Daniel
D
Fried
Michael
M
Castell
Donald O
DO
Tutuian
Radu
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001939:Bread; D002637:Chest Pain; D016009:Chi-Square Distribution; D003679:Deglutition; D003680:Deglutition Disorders / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011187:Posture; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014867:Water
D014867:Water