Introduction In patients with dysphagia, confirmation of obstruction at the oesophago-gastric junction (OGJ) is used to decide further endoscopic or surgical therapy. This is true for both untreated and treated patients with persistent dysphagia. A 200 ml rapid drink challenge (RDC) during high resolution manometry (HRM) may aid diagnosis of oesophageal motility disorders (Marin &Serra NGM 2016). Timed barium oesophagogram (TBO) detects impaired oesophageal emptying of liquids. We hypothesised that O-G pressure parameters during RDC could predict pathologic barium column in TBO. We aimed to assess the ability of RDC to diagnose obstruction at the OGJ in a group of untreated and treated patients with dysphagia.
Method 30 patients with dysphagia (mean age 50y) were prospectively included. All patients underwent HRM (Medtronic; Sandhill) with standard protocol plus RDC followed by TBO. HRM analysis was in accordance with the Chicago Classification v3.0. Analysis of RDC included all parameters described by Marin & Serra 2016; cutoff points for each were determined using a ROC curve analysis. During TBO, oesophageal emptying was assessed at minutes 1, 3 and 5. Persistent barium column at 5 min was diagnostic of OGJ obstruction.
Results Of 30 patients, 19 patients were untreated; 11 patients were previously treated (5 dilation, 6 myotomy). HRM diagnoses: 3 normal, 23 achalasia (type I=4, II=18, III=1), 1 aperistalsis, 1 distal oesophageal spasm. Overall, the RDC parameter that best predicted OGJ obstruction during TBO was IRP/200 ml (cutoff >17mmHg: sensitivity=75%, specificity=90%). Subgroup analysis: Prediction of obstruction during TBO by the RDC test further improved in the untreated group (sensitivity 100%; specificity 85.5%) but not for the treated group (sensitivity 50%; sensitivity 66%).
Abstract PTH-138 Table 1 All patients (n=30)
Abstract PTH-138 Table 2a Untreated population (n=19)
Abstract PTH-138 Table 2b Treated population (n=11)
Conclusion RDC during HRM is a useful adjuvant to improve diagnosis of OGJ obstruction, particularly in untreated dysphagia.
Disclosure of Interest S. Sonmez: None Declared, J Arguero: None Declared, J Ooi: None Declared, K Nakagawa: None Declared, E Glasinovic: None Declared, P Woodland: None Declared, E Yazaki: None Declared, D Sifrim Conflict with: Reckitt Benckiser (Hull, UK); Sandhill Scientific (CO, USA)
- barium swallow
- high resolution manometry
- OGJ obstruction
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.