How provocative tests in addition to wet swallows during high-resolution manometry can direct clinical management.
Journal
Current opinion in gastroenterology
ISSN: 1531-7056
Titre abrégé: Curr Opin Gastroenterol
Pays: United States
ID NLM: 8506887
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
entrez:
28
6
2022
pubmed:
29
6
2022
medline:
1
7
2022
Statut:
ppublish
Résumé
Provocative tests have been advocated to address limitations of high-resolution manometry (HRM) with wet swallows. We describe the commonly used provocative manometric manoeuvres [rapid drink challenge (RDC), multiple rapid swallows (MRS), solid swallows and the solid test meal (STM)], compare their diagnostic yield and accuracy to wet swallows, and outline their role in directing clinical management. Provocative testing with RDC and STM identifies a proportion of achalasia cases missed by standard testing, and RDC can play a similar role to radiology in the evaluation of treatment response. In EGJOO, provocative testing with RDC and STM not only increase the diagnostic yield, but can also help differentiate between spurious cases and those representing true outflow obstruction likely to respond to achalasia-type therapies. MRS and STM can help determine the clinical relevance (or otherwise) of ineffective oesophageal motility, and in this setting, MRS may predict the likelihood of postfundoplication dysphagia. RDC and STM can help identify cases of postfundoplication dysphagia more likely to respond to dilatation. Provocative testing has been shown to increase diagnostic yield of HRM, clarify inconclusive diagnoses, allows corroboration of dysmotility with patient symptoms and helps direct clinical management.
Identifiants
pubmed: 35762700
doi: 10.1097/MOG.0000000000000848
pii: 00001574-202207000-00012
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
402-410Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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