BACKGROUND Standard high-resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position. AIMS To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders. METHODS Seventy-two healthy volunteers (20-76 years) and 366 consecutive patients (18-90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests. RESULTS Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = .0007). Similarly, the difference in concordance for the diagnosis of oesophago-gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = .0087). CONCLUSION Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.

中文翻译：

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前瞻性系列诊断研究：位置和刺激性测试对高分辨率测压法诊断食管运动性障碍的影响。

背景技术标准的高分辨率测压法（HRM）协议是基于仰卧位采集的10只单个燕子。目的评估位置，快速饮酒挑战和固体测试餐对食道运动障碍诊断的影响。方法72名健康志愿者（20-76岁）和366名连续患者（18-90岁）通过仰卧位和直立位10只水吞咽完成了HRM。在固体测试餐前后分别进行了两次快速饮料攻击。将基于仰卧位单个燕子的诊断（芝加哥分类v3.0）与竖立位置的结果和刺激性测试进行了比较。结果总体而言，在296/438（67.6％）的受试者中存在仰卧和直立位置的诊断一致性。这增加到90。当认为无效的食道运动与正常运动时为0％。仰卧位的综合松弛压力高4 mm Hg。与仰卧位相比，仰卧位不一致，可能为假阳性的诊断患病率更高（16/20对1/4患者，P = .0007）。同样地，仰卧位和垂直位上含固体测试餐的单只水吞下食管-胃交界处梗阻或门失弛缓的诊断一致性显着（12/29（41.4％）vs 12/14（85.7％）， P = .0087）。结论基于直立和仰卧位的单只吞水燕对食管运动障碍的诊断结果是中等的，对于无效的运动和出口阻塞经常出现不一致的发现。可以使用适当的参考值在任何位置进行HRM研究。快速饮酒或固体测试餐可以解决诊断上的差异。