THE INFLUENCE OF A MANOMETRIC TUBE ON RADIONUCLIDE TRANSIT OF LIQUID AND SEMISOLID BOLUSES

Twenty-nine patients referred for oesophageal diagnostic work up prosp ectively divided into patients with normal ('controls') and abnormal m otility on the basis of manometric findings underwent oesophageal scin tigraphy with and without simultaneous manometry. All patients with ab normal peristalsis had a mean pressure amplitude of less than 30 mm Hg and/or simultaneous Contractions in the proximal and/or distal half o f the oesophagus. For manometry a low compliance perfusion system was used (external diameter of the manometric tube 0.5 cm). Radionuclide o esophageal emptying (%) was measured 12 sec after the beginning of eac h swallow Values of > 80% were considered normal. Oesophageal emptying for liquid and semi-solid test-boluses during manometry was compared to the corresponding values obtained without the manometric tube in pl ace. Oesophageal emptying was reduced during studies with the manometr ic tube in situ in controls from 97.6 +/- 1.2% to 85.9 +/- 5.3%, P = 0 .018 for liquid boluses, and from 95.3 +/- 1.2% to 84.4 +/- 4.3%, P = 0.01 for semi-solid boluses. A trend was also seen in patients with ab normal contractility which was not statistically significant (65.6 +/- 9.0% vs 56.6 +/- 8.5%, P = 0.1, 62.4 +/- 9.1% vs 56.7 +/- 7.6%, P = 0 .4). Three controls during liquid studies and four controls during sem i-solid studies were falsely classified as pathological by scintigraph y with the tube in situ whereas only one patient with abnormal contrac tility was classified normal in each of the liquid and semi-solid stud ies. In conclusion, subjects with normal contractility patterns may sh ow pathological emptying in radionuclide studies if simultaneous manom etry is performed. Patients who have reduced oesophageal emptying may be less often falsely classified as normal.