LAUSR

Introduction Patients attending the oesophageal laboratory mainly complaining of dysphagia are generally to solid food. However current motility assessment to diagnose achalasia and the subtype are based on water swallows [1]. In this study, we investigate the correlation between liquid swallow and solid swallow in patients with achalasia. Method Patients were selected based Chicago Classification (version 3)[1] between January and December of 2018. High-resolution manometry was performed using the Sierra Scientific Instruments with 36-channel solid-state catheter and Manoscan 3.0.1 was used to capture the recording. Solid bolus swallows were performed using bread with butter sandwich meal and motility assessment (including distal contractile integral values) was based on [2]. Inter-rater reliability (IRR) was calculated between liquid swallow and solid swallow in the achalasia subtypes. Fisher exact was employed to find investigate statistical differences in the IRR between achalasia subtypes during liquid swallow and solid swallow. Results Patients selected (F:M=45:43, aged =1–7 years) were of subtype 1, 2, and 3 respectively of 39.8%, 60.2% and 0% based on water swallows. The total number of patients performing liquid and solid bolus swallows in achalasia subtypes 1 and 2 were 29 and 38. The inter-rater agreement between liquid swallow and solid swallow in achalasia subtypes 1 and 2 were 37.9% and 86.8% (p<0.0001). Conclusion Achalasia type 2 shows strong agreement between liquid bolus swallow and solid bolus swallow. Majority of type 1 achalasia on solid swallows were not consistent with the primary diagnosis made by liquid swallow. Reference Kahrilas PJ, et al. The Chicago Classification of Esophageal Motility Disorders, v3.0Neurogastroenterol Motil 2015;27(2):160–174. Sweis RT, et al. Normal values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry. Neurogastroenterol Motil 2011;23(6):509–516.