Division of Gastroenterology-Hepatology, Department of Medicine, Albany Medical College, Albany, NY, USA.
Albany Med Gastroenterology, 1769 Union Street 2nd Floor, Niskayuna Medical Arts Bldg., Schenectady, NY, 12309, USA.
Esophagus. 2021 Apr;18(2):353-361. doi: 10.1007/s10388-020-00784-z. Epub 2020 Oct 4.
High-resolution manometry (HRM) is a gastrointestinal motility diagnostic system that measures intraluminal pressures using closely aligned sensors. Multiple rapid swallows (MRS) are used in conjunction with HRM to assess esophageal physiology prior to anti-reflux and hiatal hernia procedures.
A retrospective, qualitative study was conducted on 90 patients who underwent HRM with MRS in a single community clinic. 80 patients met the inclusion criteria. MRS testing consisted of rapid 2 mL swallows in 2-3 s intervals with patients in a seated, upright position. Clinical information was reviewed including indications for HRM, prior diagnostic workup, manometry, distal contractile integral (DCI), and integrated residual pressure (IRP). HRM studies were visualized using Manoview Analysis Software v3.0 (Medtronic).
Certain esophageal dysmotility and pressurization manometry patterns were previously undetected on HRM alone. In our study, the addition of MRS was clinically helpful in (1) assessing contraction reserve, (2) highlighting features of jackhammer, (3) stimulating esophageal spasm, and (4) visualizing distal esophageal pressurization pattern with mechanical obstruction. Additionally, abnormal pathophysiology such as (5) paradoxical LES contraction (achalasia) and (6) loss of deglutition inhibition were identified. MRS had a diagnostic utility of 21.25% (n = 17) among the 80 patients. An intolerance rate of 7.7% (n = 7) was observed in patients unable to complete the protocol.
Augmentation of HRM with MRS produces unique manometric features that have clinical utility in uncovering esophageal disorders. MRS provocation testing is a practical, inexpensive, well-tolerated addition to HRM that may yield useful clinical information to guide complicated diagnoses and medical management.
高分辨率测压（HRM）是一种胃肠道动力诊断系统，它使用紧密排列的传感器测量腔内压力。在进行抗反流和食管裂孔疝手术之前，通常会结合 HRM 使用多次快速吞咽（MRS）来评估食管生理功能。
在一家社区诊所中，对 90 例行 HRM 和 MRS 的患者进行了回顾性、定性研究。其中 80 例患者符合纳入标准。MRS 测试由患者取坐立、直立位，在 2-3 秒间隔内快速吞咽 2 毫升水组成。回顾了临床信息，包括 HRM 的适应证、先前的诊断性检查、测压、远端收缩积分（DCI）和残余压（IRP）。使用 Manoview 分析软件 v3.0（美敦力）可视化 HRM 研究。
某些食管动力障碍和压力测压模式在单独进行 HRM 时无法检测到。在我们的研究中，MRS 的添加在以下方面具有临床帮助：（1）评估收缩储备，（2）突出“链锯”特征，（3）刺激食管痉挛，以及（4）可视化机械性梗阻时的远端食管加压模式。此外，还确定了异常的病理生理学现象，如（5）反常的食管下括约肌收缩（贲门失弛缓症）和（6）吞咽抑制丧失。80 例患者中，MRS 的诊断效用为 21.25%（n=17）。在无法完成方案的患者中，观察到不耐受率为 7.7%（n=7）。
HRM 联合 MRS 可产生独特的测压特征，有助于发现食管疾病。MRS 激发试验是 HRM 的一种实用、经济、耐受性良好的附加检查，可提供有用的临床信息，有助于指导复杂的诊断和医学管理。
