Introduction High resolution manometry (HRM) is currently the gold standard technique to investigate oesophageal motility in patients with dysphagia. However, with routine HRM procedure and use of Chicago classification, a group of patients with dysphagia are considered as being normal and dysphagia remains unexplained.

The aim of this study is to assess the diagnostic value of solid bolus swallows in patients with dysphagia and normal HRM.

Methods Patients having dysphagia and normal HRM studies during January-October 2015 were selected. Solid bolus swallows of bread (1cm³ single bread swallows and/or a sandwich meal) followed the routine water swallows on HRM. Patients with a double high pressure zone, oesophageal diverticulum or history of antireflux surgery were excluded. The patients were categorised to symptomatic and asymptomatic groups based on having dysphagia reproduced on bread swallows. Hospital odynophagia and dysphagia questionnaire (HODQ) score, integrated relaxation pressure (IRP), distal contractile integration (DCI), distal latency (DL) and peristaltic abnormality during water swallows were investigated and compared between groups. ROC curve was used to identify the optimum level of sensitivity and specificity of the significant parameters in identifying patients who have a meaningful abnormality on bread swallows. Student t-test is used to compare significance of differences. P value <0.05 was considered as significant.

Results 72 patients referred with dysphagia and diagnosed with normal HRM were selected.

In the asymptomatic group, 7/22 patients showed abnormality on bread swallows and in the symptomatic group, 45/50 showed abnormal motility (P = 0.0001). ROC analysis showed that having >33.3% abnormal bread swallows has sensitivity of 72%, specificity of 90.91% and likelihood ratio of 7.9 to detect patients who may have abnormal motility and dysphagia on bread swallows. Analysis of water swallow parameters comparing the asymptomatic group against the symptomatic group with abnormal motility on bread swallows did not reveal any significant difference in HODQ score (P = 0.2), IRP (P = 0.17), DL (P = 0.3) and peristaltic abnormalities (P = 0.4).

Conclusion Performing solid swallows on HRM can explain dysphagia in a considerable number of patients with dysphagia and normal routine HRM. This complementary test is readily available, and avoids the need for Barium swallowing and radiation exposure.

Disclosure of Interest None Declared