Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry

2020 ◽  
Vol 51 (7) ◽  
pp. 706-718 ◽  
Author(s):  
Benjamin Misselwitz ◽  
Michael Hollenstein ◽  
Simon Bütikofer ◽  
Daphne Ang ◽  
Henriette Heinrich ◽  
...  
Keyword(s):  
High Resolution ◽  
Diagnostic Study ◽  
Oesophageal Motility ◽  
Motility Disorders ◽  
High Resolution Manometry

scholarly journals Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

2017 ◽  
Vol 14 (11) ◽  
pp. 677-688 ◽  
Author(s):  
Peter J. Kahrilas ◽  
◽  
Albert J. Bredenoord ◽  
Mark Fox ◽  
C. Prakash Gyawali ◽  
...  
Keyword(s):  
High Resolution ◽  
Outlet Obstruction ◽  
Lower Oesophageal Sphincter ◽  
Patient Specific ◽  
Invasive Technique ◽  
Pneumatic Dilation ◽  
Type I ◽  
Oesophageal Motility ◽  
Motility Disorders ◽  
High Resolution Manometry

Abstract High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia — impaired lower oesophageal sphincter (LES) relaxation — can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies such as pneumatic dilation for the disorders limited to the LES. This Consensus Statement examines the effect of HRM on our understanding of oesophageal motility disorders, with a focus on the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes.

scholarly journals Solid Swallow Examination During High Resolution Manometry and EGJ-Distensibility Help Identify Esophageal Outflow Obstruction in Non-obstructive Dysphagia

Dysphagia ◽  
2021 ◽  
Author(s):  
Fritz Ruprecht Murray ◽  
Lara Maria Fischbach ◽  
Valeria Schindler ◽  
Larissa Schnurre ◽  
Juliane Marie Hente ◽  
...  
Keyword(s):  
High Resolution ◽  
Diagnostic Yield ◽  
Diagnostic Value ◽  
Control Group ◽  
Clinical Response Rate ◽  
Interventional Treatment ◽  
Outflow Obstruction ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Solid Swallows

AbstractSingle water swallow (SWS) high-resolution manometry (HRM) may miss relevant esophageal motility disorders. Solid test meal (STM) during HRM and lately the functional lumen imaging probe (FLIP) have been shown to be of diagnostic value in the assessment of motility disorders. We aimed to assess the diagnostic yield of STM and FLIP in non-obstructive dysphagia (NOD). Patients assessed for dysphagia with both HRM and FLIP between April 2016 and August 2019 were analyzed for signs of non-obstructive EGJ outflow obstruction (EGJOO) according to Chicago Classification 3.0 (CCv3) and CC adapted for the use with solid swallows (CC-S), followed by an individual group-specific analysis. Five subjects without dysphagia served as control group. Standard HRM- and FLIP-values as well as esophagograms and Eckardt Scores were analyzed. Forty-two patients were identified (male/female, 14/36, median age 62). Twenty-five (59.5%) were diagnosed with EGJOO during STM only (= SWS-negative patients; CC-S). The EGJ distensibility index (EGJ-DI) of symptomatic patients was significantly lower compared to the control group (p = 0.006). EGJ-DI was < 3mm2/mmHg in 67% and 88% of patients diagnosed according to CC-S and CCv3, respectively. The IRP during STM showed a significant association to the corresponding EGJ-DI values (p < 0.001). Seventy-six percent of patients received treatment because of additional STM evaluation with a favorable clinical response rate of 89%. STM and FLIP identify EGJOO in symptomatic patients with normal SWS during HRM. STM resembles an inexpensive and clinically meaningful option to diagnose motility disorders and helps to select patients for interventional treatment.

Interobserver Agreement in the Assessment of High-resolution Manometry Recordings in Patients with Non-Achalasic Motility Disorders

2012 ◽  
Vol 107 ◽  
pp. S24
Author(s):  
Elena Sidorenko ◽  
Tuba Esfandyari ◽  
Mandeep Singh ◽  
Rajeswari Anaparthy ◽  
Krishna Rayapudi ◽  
...  
Keyword(s):  
High Resolution ◽  
Interobserver Agreement ◽  
Motility Disorders ◽  
High Resolution Manometry
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