title: Apple sauce improves detection of esophageal motor dysfunction during high-resolution manometry evaluation of dysphagia.
abstract: BACKGROUND
  Esophageal manometry utilizes water swallows to evaluate esophageal motor abnormalities in patients with dysphagia, chest pain, or reflux symptoms. Although manometry is the gold standard for evaluation of these symptoms, patients with dysphagia often have normal results in manometry studies.
  
  
  OBJECTIVE
  The objective of this work was to test the hypothesis that challenging the esophagus with viscous apple sauce boluses uncovers motor abnormalities in patients with dysphagia not seen when using water swallows.
  
  
  METHODS
  High-resolution esophageal manometry was performed using ten water swallows followed by ten apple sauce swallows in consecutive subjects presenting with dysphagia. Subjects with grossly abnormal water swallow evaluations were excluded. Each swallow was categorized as normal, hypotensive (distal isobaric contour plots of < 30 mmHg over >5 cm), or simultaneous (distal esophageal velocity ≥ 8.0 cm/s). Ineffective esophageal motility (IEM) was defined as ≥ 30% hypotensive swallows, and pressurization was defined as ≥ 20% simultaneous pressure waves.
  
  
  RESULTS
  Data from 41 subjects was evaluated. Overall, 96.3% of water swallows were normal, 2.9% hypotensive, and 0.7% simultaneous. Only 70.3% of viscous swallows were normal; 16.7% were hypotensive and 13.0% were simultaneous (P < 0.001 all groups). Seven (17.1%) met criteria for IEM, and pressurization with viscous swallows was observed for nine (22.0%). Fourteen subjects (34.1%) had abnormal results from viscous studies. The presence of any abnormal water swallows was predictive of abnormal viscous swallows (OR = 9.00, CI = 2.15-80.0), although the presence of hypotensive or simultaneous water swallows was not associated with IEM (OR = 0.63, CI = 0.16-2.17) or pressurization (OR = 7.00, CI = 0.90-315.4) with viscous apple sauce.
  
  
  CONCLUSIONS
  Apple sauce challenge increased identification of classifiable motor disorders in patients with dysphagia and may be preferred to alternative bolus materials.
authors.affiliation: GI Motility Program, Division of Gastroenterology, Cedars-Sinai Medical Center, 8730 Alden Drive, Suite 225E, Los Angeles, CA 90048, USA. Benjamin.Basseri@cshs.org
authors.forename: Benjamin
authors.initials: B
authors.lastname: Basseri
authors.forename: Mark
authors.initials: M
authors.lastname: Pimentel
authors.forename: Omid A
authors.initials: OA
authors.lastname: Shaye
authors.forename: Kimberly
authors.initials: K
authors.lastname: Low
authors.forename: Edy E
authors.initials: EE
authors.lastname: Soffer
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Conklin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis*; D050782:Esophageal pH Monitoring; D005260:Female; D006801:Humans; D008297:Male; D027845:Malus; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water