Introduction The oesophageal absent contractility diagnosis is a major motility disorder according to the Chicago Classification (CC)  that is based on failing to produce peristalsis with distal contractile integration (DCI) of ≥100 mmHgscm.
Aim To challenge the oesophagus with multiple water swallows (MWS) and solid bolus swallows (SBS) and examine for remaining effective peristaltic activity
Method Patients selected for study underwent high-resolution manometry (HRM) testing using Sierra Scientific Instruments complementary system (36-channel solid-state catheter and Manoscan 360 data recording device). Patients diagnosed with absent contractility according to CC (version 3) between September 2014 and December 2016 underwent MWS and SBS assessment for remaining peristaltic activity. Effective peristalsis were accepted when normal values of contractile front velocity and distal latency during swallows were met (i.e.≤6.25 cm/s and >4.2s respectively) in addition to demonstrating post-MWS peristalsis with DCI ≥100 mmHgscm  and/or SBS with sandwich meal generating peristalsis with DCI ≥405 mmHgscm (DCI values for SBS in normal population between 5%–95% are 404.6–5845.6mmHgscm ). The transition zone (TZ) measured during peristaltic activity was at 20 mmHg isobaric contouring.
Results Number of patients diagnosed with absent contractility was 47 (M:F=19:28, mean age 52 years[18–75 years]),17/47 patients (36.2% of the total cases) produced effective peristaltic activity with MWS and/or SBS.
Seven of the 47 patients (14.9%) demonstrated effective peristalsis with MWS with maximum DCI of 686.3mmHgscm and smallest TZ of 1.9 cm. Of which, MWS generated peristalsis with normal DCI (534–686.3mmHgscm) in 3 of the 7 patients (6.4% of the total cases) and 4 of the 7 patients who produced effective peristalsis to MWS response did not produce peristaltic activity with SBS (8.5% of the total cases).
43/47 patients performed SBS and 13 of the 43 patients (30.2%) produced normal peristalsis in total of 35 swallows (highest DCI=1750 mmHgscm, smallest TZ=0 cm). 10/43 patients (23.3%) produced normal peristalsis during SBS but did not respond to MWS.
Conclusion More than 1/3 of patients with absent contractility have remaining peristaltic activity on MWS and/or SBS which may have profound impact to oesophageal acid clearance and treatment strategy.
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. Sweis RTet al. Normal values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry. Neurogastroenterol Motil2011;23(6):509–516.
Disclosure of Interest None Declared
- chicago classification