title: Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve.
abstract: OBJECTIVE
  Dysphagia may develop following antireflux surgery as a consequence of poor esophageal peristaltic reserve. We hypothesized that suboptimal contraction response following multiple rapid swallows (MRS) could be associated with chronic transit symptoms following antireflux surgery.
  
  
  METHODS
  Wet swallow and MRS responses on esophageal high-resolution manometry (HRM) were characterized collectively in the esophageal body (distal contractile integral (DCI)), and individually in each smooth muscle contraction segment (S2 and S3 amplitudes) in 63 patients undergoing antireflux surgery and in 18 healthy controls. Dysphagia was assessed using symptom questionnaires. The MRS/wet swallow ratios were calculated for S2 and S3 peak amplitudes and DCI. MRS responses were compared in patients with and without late postoperative dysphagia following antireflux surgery.
  
  
  RESULTS
  Augmentation of smooth muscle contraction (MRS/wet swallow ratios >1.0) as measured collectively by DCI was seen in only 11.1% with late postoperative dysphagia, compared with 63.6% in those with no dysphagia and 78.1% in controls (P≤0.02 for each comparison). Similar results were seen with S3 but not S2 peak amplitude ratios. Receiver operating characteristics identified a DCI MRS/wet swallow ratio threshold of 0.85 in segregating patients with late postoperative dysphagia from those with no postoperative dysphagia with a sensitivity of 0.67 and specificity of 0.64.
  
  
  CONCLUSIONS
  Lack of augmentation of smooth muscle contraction following MRS is associated with late postoperative dysphagia following antireflux surgery, suggesting that MRS responses could assess esophageal smooth muscle peristaltic reserve. Further research is warranted to determine if antireflux surgery needs to be tailored to the MRS response.
authors.affiliation: Division of Gastroenterology, and the Section of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Anisa
authors.initials: A
authors.lastname: Shaker
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Stoikes
authors.forename: Jesse
authors.initials: J
authors.lastname: Drapekin
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kushnir
authors.forename: L Michael
authors.initials: LM
authors.lastname: Brunt
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008365:Manometry; D009119:Muscle Contraction / Q000502:physiology; D009130:Muscle, Smooth / Q000503:physiopathology; D010528:Peristalsis / Q000502:physiology*
references.citation: Neurogastroenterol Motil. 2012 Aug;24(8):763-8, e353
references.pmid: 22616632
references.citation: Am J Gastroenterol. 2012 Nov;107(11):1647-54
references.pmid: 22929758
references.citation: Dig Dis Sci. 2011 Jun;56(6):1723-8
references.pmid: 21181443
references.citation: J Neurogastroenterol Motil. 2012 Jan;18(1):6-12
references.pmid: 22323983
references.citation: Neurogastroenterol Motil. 2009 Jul;21(7):718-e41
references.pmid: 19222762
references.citation: Am J Gastroenterol. 2008 Jan;103(1):27-37
references.pmid: 17900331
references.citation: Surg Endosc. 2011 Sep;25(9):2943-9
references.pmid: 21424193
references.citation: Dig Dis Sci. 1985 Nov;30(11):1065-71
references.pmid: 4053917
references.citation: Surg Endosc. 2012 Dec;26(12):3401-7
references.pmid: 22648115
references.citation: Am J Gastroenterol. 2011 Feb;106(2):349-56
references.pmid: 20924368
references.citation: Neurogastroenterol Motil. 2011 Feb;23(2):139-44, e27-8
references.pmid: 20939855
references.citation: Neurogastroenterol Motil. 2011 Jun;23(6):502-e197
references.pmid: 21303431
references.citation: Neurogastroenterol Motil. 2013 Feb;25(2):99-133
references.pmid: 23336590
references.citation: Gastroenterology. 1992 Sep;103(3):876-82
references.pmid: 1499938