HOT-WATER SWALLOWS IMPROVE SYMPTOMS AND ACCELERATE ESOPHAGEAL CLEARANCE IN ESOPHAGEAL MOTILITY DISORDERS

Cold liquid ingestion may precipitate episodes of dysphagia and chest pain in patients with spastic esophageal motility disorders. The effec t of hot liquids an esophageal symptoms, esophageal peristalsis, and c learance and any potential therapeutic benefit in such patients has no t been examined. Using esophageal scintigraphy and manometry, we have investigated the effects of hot water swallows on dysphagia, chest pai n, and esophageal motility and clearance in patients with esophageal m otility disorders. We studied 48 men and women with intermittent dysph agia to both solids and liquids, chest pain, and/or regurgitation. All patients underwent upper endoscopy, barium swallow, and esophageal ma nometry using standard techniques. Esophageal scintigraphy assessed es ophageal transit time (ETT) and retrograde intraesophageal movement of bolus at baseline (22 degrees C) and after hot (60 degrees C) water s wallows. Esophageal manometry assessed the amplitude and duration of e sophageal contractions in response to baseline and hot water swallows. Patients were followed clinically for as long as 6 months to assess s ymptomatic response. We found that baseline esophageal scintigraphy re vealed a mean ETT of 48.5 seconds; after hot water swallow, mean ETT w as 27.8 seconds (p < 0.001). The number of secondary peaks at baseline was 3.5; after hot water swallow, it was 2.1 (p < 0.001). Baseline es ophageal manometry showed a mean esophageal body contraction amplitude of 188 mm Hg (mean duration, 11.8 seconds) in response to wet swallow s and 125 mm Hg (mean duration, 5.7 seconds) with hot water swallows ( p < 0.001). Clinically, 28 (58%) of 48 patients noted significant (>50 %) improvement of their symptoms and have been ingesting hot water or other hot liquids regularly with their meals. We conclude that hot wat er accelerates esophageal clearance, decreases the amplitude and durat ion of esophageal body contractions, and improves symptoms in patients with esophageal motility disorders. Because of its safety and simplic ity, it may have an important role in the management of these chronic conditions.