Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Neurogastroenterol Motil. 2018 Nov;30(11):e13404. doi: 10.1111/nmo.13404. Epub 2018 Jul 10.
Esophageal stasis is a hallmark of achalasia. Timed barium esophagogram (TBE) is used to measure stasis but exposes patients to ionizing radiation. It is suggested that esophageal stasis can be objectified on high-resolution manometry (HRM) as well using a rapid drinking challenge test (RDC). We aimed to assess esophageal stasis in achalasia by a RDC during HRM and compare this to TBE.
Thirty healthy subjects (15 male, age 40 [IQR 34-49]) and 90 achalasia patients (53 male, age 47 [36-59], 30 untreated/30 treated symptomatic/30 treated asymptomatic) were prospectively included to undergo HRM with RDC and TBE. RDC was performed by drinking 200 mL of water. Response to RDC was measured by basal and relaxation pressure in the esophagogastric junction (EGJ) and esophageal pressurization during the last 5 seconds.
EGJ basal and relaxation pressure during RDC were higher in achalasia compared to healthy subjects (overall P < .01). Esophageal body pressurization was significantly higher in untreated (43 [33-35 mm Hg]) and symptomatic treated patients (25 [16-32] mm Hg) compared to healthy subjects (6 [3-7] mm Hg) and asymptomatic treated patients (11 [8-15] mm Hg, overall P < .01). A strong correlation was observed between esophageal pressurization during RDC and barium column height at 5 minutes on TBE (r = .75, P < .01), comparable to the standard predictor of esophageal stasis, IRP (r = .66, P < .01).
CONCLUSIONS & INFERENCES: The RDC can reliably predict esophageal stasis in achalasia and adequately measure treatment response to a degree comparable to TBE. We propose to add this simple test to each HRM study in achalasia patients.
食管淤滞是贲门失弛缓症的一个标志。钡餐食管测压（TBE）用于测量淤滞，但会使患者暴露在电离辐射下。有人提出，食管淤滞也可以通过高分辨率测压（HRM）和快速饮水挑战测试（RDC）来客观化。我们旨在通过 HRM 期间的 RDC 评估贲门失弛缓症中的食管淤滞，并将其与 TBE 进行比较。
30 名健康受试者（15 名男性，年龄 40 [IQR 34-49]）和 90 名贲门失弛缓症患者（53 名男性，年龄 47 [36-59]，30 名未治疗/30 名有症状治疗/30 名无症状治疗）前瞻性纳入 HRM 联合 RDC 和 TBE。RDC 通过饮用 200ml 水进行。通过食管胃交界处（EGJ）的基础和松弛压力以及最后 5 秒食管加压来测量对 RDC 的反应。
与健康受试者相比，RDC 时 EGJ 的基础和松弛压力在贲门失弛缓症患者中更高（总体 P<.01）。未治疗（43 [33-35mmHg]）和有症状治疗患者（25 [16-32]mmHg）的食管体加压明显高于健康受试者（6 [3-7]mmHg）和无症状治疗患者（11 [8-15]mmHg，总体 P<.01）。RDC 期间的食管加压与 TBE 时 5 分钟的钡柱高度之间存在很强的相关性（r=0.75，P<.01），与食管淤滞的标准预测指标 IRP（r=0.66，P<.01）相当。
RDC 可以可靠地预测贲门失弛缓症中的食管淤滞，并能在一定程度上充分测量治疗反应，与 TBE 相当。我们建议在每个贲门失弛缓症患者的 HRM 研究中添加此简单测试。
