Patterns of esophageal pressure responses to a rapid drink challenge test in patients with esophageal motility disorders

Background Multiple rapid swallow has been proposed as a challenge test that can help diagnosis and management of patients with esophageal motility disorders. Our aim was to characterize specific pressure patterns in response to a rapid drink challenge test in patients with esophageal motility disorders, and to determine the potential of these patterns in the diagnosis of patients with esophageal symptoms but normal single swallow manometry. Methods Pressure responses to a rapid drink challenge test (rapid swallow of 200 mL water) were prospectively analyzed in 30 healthy controls and 285 patients with esophageal symptoms: 33 achalasia, 68 hypocontractile motility, 27 hypercontractile motility and 160 patients with normal manometry. Key Results Three different patterns of responses were characterized: (i) hypopressive or normal pattern that was shared by healthy subjects and patients with hypocontractile peristalsis, and discriminated patients with non‐obstructive hypercontractile motility or achalasia (p < 0.001; sensitivity 80% and specificity 93%), (ii) brief hyperpressive pattern observed in patients with non‐obstructive hypercontractile disorders (distal spasm and hypercontractile esophagus), and (iii) prolonged hyperpressive pattern, that discriminated achalasia from patients with non‐obstructive hypercontractile disorders (p < 0.001; sensitivity 70% and specificity 85%). Seventeen percent of patients with esophageal symptoms but normal single swallow manometry had abnormal responses to the drink challenge test: 14% a brief hyperpressive pattern, and 3% a prolonged hyperpressive pattern. Conclusions & Inferences Specific patterns of responses to a rapid drink challenge test could help identification of motility disorders in patients with esophageal symptoms but unclear or normal esophageal manometry. Specific motor patterns elicited by a rapid drink challenge test discriminate between different groups of esophageal motility disorders, and detect abnormal motor responses in patients with clinical suspicion of esophageal motility disorders but normal HRM. To characterize specific pressure patterns in diverse esophageal motility disorders and to determine the potential of these patterns in the diagnosis of patients with normal manometry, a 200‐mL multiple swallow test was performed in 30 healthy controls and 285 patients with esophageal motility disorders. Three different patterns of responses were characterized, that discriminated: (i) healthy subjects