Читать книгу The Esophagus - Группа авторов - Страница 219

The standard manometric protocol involves ten 5 ml liquid swallows performed in the supine (or semi‐supine, e.g. head raised 30 degrees) position [3, 4, 21]. While acknowledging that this position does not mirror ingestion in real life, it is a form of stress test for the esophagus to uncover motor abnormalities, analogous to running on a treadmill during a cardiac stress test. Further, standardization and consistency in the manometric test protocol are important as differences in bolus size, consistency, and patient position can all affect the pressure output [8]. Using the IRP as an example, when compared with a 5 ml liquid, supine swallow, the IRP would increase with larger bolus volume or thicker bolus consistency (e.g. viscous or solid) and decrease in the upright posture [8, 22, 23].

While the supine liquid swallow protocol forms the standard assessment and the basis for classification of esophageal motor disorders, restricting the study to only these 10 swallows carries limitations of both potentially missing clinically significant abnormalities in symptomatic patients and potentially “over‐calling” some abnormalities – EGJ outflow obstruction in particular. Hence, various additional maneuvers to supplement the standard supine liquid swallows have been proposed and are gaining interest in recent years. While not an exhaustive list, these potentially include upright liquid swallows, viscous swallows, solid bolus swallows, multiple rapid swallows, a rapid drink challenge, a solid test meal, and post‐prandial monitoring. These are discussed in greater detail next.