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Rapid drinking challenge during high‐resolution manometry is complementary to timed barium esophagogram for diagnosis and follow‐up of achalasia
Author(s) -
Ponds F. A.,
Oors J. M.,
Smout A. J. P. M.,
Bredenoord A. J.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13404
Subject(s) - achalasia , asymptomatic , medicine , high resolution manometry , reflux , gastroenterology , esophagus , basal (medicine) , nuclear medicine , disease , insulin
Background Esophageal stasis is a hallmark of achalasia. Timed barium esophagogram ( TBE ) is used to measure stasis but exposes patients to ionizing radiation. It is suggested that esophageal stasis can be objectified on high‐resolution manometry ( HRM ) as well using a rapid drinking challenge test ( RDC ). We aimed to assess esophageal stasis in achalasia by a RDC during HRM and compare this to TBE . Methods Thirty healthy subjects (15 male, age 40 [ IQR 34‐49]) and 90 achalasia patients (53 male, age 47 [36‐59], 30 untreated/30 treated symptomatic/30 treated asymptomatic) were prospectively included to undergo HRM with RDC and TBE . RDC was performed by drinking 200 mL of water. Response to RDC was measured by basal and relaxation pressure in the esophagogastric junction ( EGJ ) and esophageal pressurization during the last 5 seconds. Key Results EGJ basal and relaxation pressure during RDC were higher in achalasia compared to healthy subjects (overall P < .01). Esophageal body pressurization was significantly higher in untreated (43 [33‐35 mm Hg]) and symptomatic treated patients (25 [16‐32] mm Hg) compared to healthy subjects (6 [3‐7] mm Hg) and asymptomatic treated patients (11 [8‐15] mm Hg, overall P < .01). A strong correlation was observed between esophageal pressurization during RDC and barium column height at 5 minutes on TBE ( r = .75, P < .01), comparable to the standard predictor of esophageal stasis, IRP ( r = .66, P < .01). Conclusions & Inferences The RDC can reliably predict esophageal stasis in achalasia and adequately measure treatment response to a degree comparable to TBE . We propose to add this simple test to each HRM study in achalasia patients.