Application of a novel straight leg raise test during high‐resolution manometry can predict esophageal contractile reserve in patients with gastroesophageal reflux disease. Issue 3 (1st October 2020)

• Record Type: Journal Article
• Authors: Lei, Wei‐Yi; Gyawali, C. Prakash; Chang, Wei‐Chuan; Roman, Sabine; Wong, Ming Wun; Yi, Chih‐Hsun; Liu, Tso‐Tsai; Hung, Jui‐Sheng; Liang, Shu‐Wei; Chen, Chien‐Lin
• Is Part Of: Neurogastroenterology & motility. Volume 33:Issue 3(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-10-01
• Subjects: esophageal contract reserve -- high‐resolution manometry -- ineffective esophageal motility -- straight leg raise test; Gastrointestinal system -- Motility -- Periodicals; Gastrointestinal system -- Innervation -- Periodicals; 616.33
• DOI: 10.1111/nmo.13996
• Languages: English
• ISSNs: 1350-1925

Abstract

Abstract: Background/aim: Increased intra‐abdominal pressure from abdominal compression augments esophageal peristalsis during high‐resolution manometry (HRM), and straight leg raise (SLR) while supine increases intra‐abdominal pressure. We determined if water swallows performed during SLR can mimic contraction reserve seen with multiple rapid swallows (MRS). Methods: Consecutive patients evaluated for GERD symptoms completed validated GERD questionnaires, esophageal HRM, and upper endoscopy. Distal contractile integral (DCI) was analyzed during single water swallows (10 × 5 mL), MRS (5 × 2 mL), and during SLR (5x5 mL). Peristaltic breaks were measured using software tools with a 20 mm Hg isobaric contour. Univariate correlational analyses were performed to compare esophageal motor patterns and DCI values during single water swallows, MRS, and SLR. Results: Of 103 study patients (mean age: 46.7 ± 12.3 years, 56.3% female), 50 (48.5%) had ineffective esophageal motility (IEM). Contraction reserve was observed on MRS in 62% with IEM, and 35.8% with normal motility ( p = 0.008). DCI was significantly higher during SLR compared to mean single swallow DCI in both IEM and normal motility patients ( p < 0.001 for each comparison). In IEM patients, SLR significantly reduced swallows with peristaltic breaks (6.1 ± 3.7 vs 3.6 ± 3.6; p < 0.001) and shortened the length of the largest break (4.8 ± 3.4 vs 3.0 ± 3.0 cm; p < 0.001). DCI response following MRS correlated with DCI with swallows during SLR, with a correlational coefficient (Pearson's r ) of 0.70 ( p < 0.001). Conclusions: Swallowing against the resistance of increased intra‐abdominal pressure from SLR improves esophageal body peristaltic performance and predicts esophageal body contraction reserve. Abstract : This study utilized HRM to investigate if water swallows during SLR can mimic contraction reserve seen with MRS. SLR not only increases esophageal body contractile vigor but also reduces swallows with peristaltic breaks. The result provides evidence that using SLR maneuver, findings similar to MRS can be obtained in patients with esophageal hypomotility.