Optimizing the swallow protocol of clinical high-resolution esophageal manometry studies

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Imaging

Background:

• The Chicago Classification (CC) for esophageal motility disorders relies on supine water swallows.
• Current protocols may not capture all diagnostic information.

Purpose of the Study:

• To evaluate if upright and provocative swallows (PS) offer additional diagnostic value in high-resolution manometry (HRM).
• To assess the impact of positional and provocative challenges on CC diagnoses.

Main Methods:

• Review of 148 high-resolution manometry (HRM) studies with supine and upright liquid swallows.
• Analysis of studies including provocative swallows (increased volume, viscosity, marshmallow).
• Defined significant diagnostic changes and used Kappa test for inter-protocol agreement.

Main Results:

• Good agreement (k=0.583) between supine and upright diagnoses.
• Upright swallows led to significant diagnostic changes in 10.1% of patients.
• Provocative swallows altered diagnoses in 18.7% of studies, notably increasing EGJ obstruction detection.

Conclusions:

• Changing position during HRM significantly impacts diagnosis in approximately 10% of cases.
• Provocative challenges enhance detection of esophagogastric junction (EGJ) outflow obstruction.
• Combining supine, upright, and provocative swallows may optimize HRM diagnostic yield.