PTH-138 200Ml rapid drink challenge during high resolution manometry predicts oesophago-gastric-junction obstruction detected by timed barium oesophagogram with high sensitivity and specificity. (17th June 2017)

• Record Type: Journal Article
• Authors: Sonmez, S; Arguero, J; Ooi, JLS; Nakagawa, K; Glasinovic, E; Woodland, P; Yazaki, E; Sifrim, D
• Is Part Of: Gut. Volume 66(2017)Supplement 2
• Page Start: A275
• Page End: A276
• Publication Date: 2017-06-17
• Subjects: barium swallow -- dysphagia -- high resolution manometry -- manometry -- OGJ obstruction; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2017-314472.537
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : 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)