BACKGROUND: Multiple rapid swallows (MRS) during esophageal high resolution manometry (HRM) assess esophageal neuromuscular integrity by evaluating postdeglutitive inhibition and rebound contraction, but most reports performed only a single MRS sequence. We assessed patterns of MRS reproducibility during clinical HRM in comparison to a normal cohort. METHODS: Consecutive clinical HRM studies were included if two separate MRS sequences (four to six rapid swallows ≤4 s apart) were successfully performed. Chicago Classification diagnoses were identified; contraction wave abnormalities were additionally recorded. MRS-induced inhibition (contraction ≤3 cm during inhibition phase) and rebound contraction was assessed, and findings compared to 18 controls (28.0 ± 0.7 year, 50.0% female). Reproducibility consisted of similar inhibition and contraction responses with both sequences; discordance was segregated into inhibition and contraction phases. KEY RESULTS: Multiple rapid swallows were successfully performed in 89.3% patients and all controls; 225 subjects (56.2 ± 0.9 year, 62.7% female) met study inclusion criteria. Multiple rapid swallows were reproducible in 76.9% patients and 94.4% controls (inhibition phase: 88.0% vs 94.4%, contraction phase 86.7% vs 100%, respectively, p = ns). A gradient of reproducibility was noted, highest in well-developed motor disorders (achalasia spectrum, hypermotility disorders, and aperistalsis, 91.7-100%, p = ns compared to controls); and lower in lesser motor disorders (contraction wave abnormalities, esophageal body hypomotility) or normal studies (62.2-70.8%, p < 0.0001 compared to well-developed motor disorders). Inhibition phase was most discordant in contraction wave abnormalities, while contraction phase was most discordant when studies were designated normal. CONCLUSIONS & INFERENCES: Multiple rapid swallows are highly reproducible, especially in well-developed motor disorders, and complement the standard wet swallow manometry protocol.
BACKGROUND: Multiple rapid swallows (MRS) during esophageal high resolution manometry (HRM) assess esophageal neuromuscular integrity by evaluating postdeglutitive inhibition and rebound contraction, but most reports performed only a single MRS sequence. We assessed patterns of MRS reproducibility during clinical HRM in comparison to a normal cohort. METHODS: Consecutive clinical HRM studies were included if two separate MRS sequences (four to six rapid swallows ≤4 s apart) were successfully performed. Chicago Classification diagnoses were identified; contraction wave abnormalities were additionally recorded. MRS-induced inhibition (contraction ≤3 cm during inhibition phase) and rebound contraction was assessed, and findings compared to 18 controls (28.0 ± 0.7 year, 50.0% female). Reproducibility consisted of similar inhibition and contraction responses with both sequences; discordance was segregated into inhibition and contraction phases. KEY RESULTS: Multiple rapid swallows were successfully performed in 89.3% patients and all controls; 225 subjects (56.2 ± 0.9 year, 62.7% female) met study inclusion criteria. Multiple rapid swallows were reproducible in 76.9% patients and 94.4% controls (inhibition phase: 88.0% vs 94.4%, contraction phase 86.7% vs 100%, respectively, p = ns). A gradient of reproducibility was noted, highest in well-developed motor disorders (achalasia spectrum, hypermotility disorders, and aperistalsis, 91.7-100%, p = ns compared to controls); and lower in lesser motor disorders (contraction wave abnormalities, esophageal body hypomotility) or normal studies (62.2-70.8%, p < 0.0001 compared to well-developed motor disorders). Inhibition phase was most discordant in contraction wave abnormalities, while contraction phase was most discordant when studies were designated normal. CONCLUSIONS & INFERENCES: Multiple rapid swallows are highly reproducible, especially in well-developed motor disorders, and complement the standard wet swallow manometry protocol.
Authors: C P Gyawali; A J Bredenoord; J L Conklin; M Fox; J E Pandolfino; J H Peters; S Roman; A Staiano; M F Vaezi Journal: Neurogastroenterol Motil Date: 2013-02 Impact factor: 3.598
Authors: Anisa Shaker; Nathaniel Stoikes; Jesse Drapekin; Vladimir Kushnir; L Michael Brunt; C Prakash Gyawali Journal: Am J Gastroenterol Date: 2013-09-10 Impact factor: 10.864
Authors: A J Bredenoord; M Fox; P J Kahrilas; J E Pandolfino; W Schwizer; A J P M Smout Journal: Neurogastroenterol Motil Date: 2012-03 Impact factor: 3.598
Authors: E R Winslow; R E Clouse; K M Desai; P Frisella; T Gunsberger; N J Soper; M E Klingensmith Journal: Surg Endosc Date: 2003-03-07 Impact factor: 4.584
Authors: Peter J Kahrilas; Albert J Bredenoord; Dustin A Carlson; John E Pandolfino Journal: Clin Gastroenterol Hepatol Date: 2018-04-24 Impact factor: 11.382
Authors: Alexandra J Baumann; Erica N Donnan; Joseph R Triggs; Wenjun Kou; Jacqueline Prescott; Alex Decorrevont; Emily Dorian; Peter J Kahrilas; John E Pandolfino; Dustin A Carlson Journal: Clin Gastroenterol Hepatol Date: 2020-03-20 Impact factor: 11.382