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High resolution manometry

Authors
Peter J Kahrilas, MD
John E Pandolfino, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Esophageal manometry is indicated in the evaluation of dysphagia or noncardiac chest pain in patients without evidence of mechanical obstruction, ulceration, or inflammation. It is also an important tool in the evaluation of gastroesophageal reflux disease (GERD), both for correct placement of pH electrodes and as an essential part of preoperative evaluation prior to antireflux procedures.

High resolution manometry (HRM) with esophageal pressure topography (EPT) plotting combines improvements in pressure sensing technology with a greatly increased number of pressure sensors and an analysis paradigm that displays data as a topographic plot that morphs anatomy and physiology.

This topic review will discuss the critical features that distinguish HRM with EPT from conventional manometry, novel metrics for EPT, a classification scheme of motility disorders developed for EPT (Chicago Classification [CC]), and will detail the diagnostic criteria within this classification scheme. The indications for motility testing, technical aspects of conventional manometry, and the clinical manifestations and management of specific motility disorders are discussed separately. (See "Overview of gastrointestinal motility testing" and "Esophageal motility disorders: Clinical manifestations, diagnosis, and management" and "Achalasia: Pathogenesis, clinical manifestations, and diagnosis" and "Overview of the treatment of achalasia".)

HIGH RESOLUTION MANOMETRY (HRM) WITH ESOPHAGEAL PRESSURE TOPOGRAPHY (EPT)

Overview — The fundamental difference between conventional manometry and high resolution manometry (HRM) is the number of pressure sensors used and the spacing between them (figure 1) [1]. (See "Overview of gastrointestinal motility testing", section on 'Esophagus'.)

In contrast to conventional manometry where sensors are spaced at 3 to 5 cm intervals, in HRM sensors are typically spaced 1 cm apart along the length of the manometric assembly. Catheters with up to 36 sensors distributed longitudinally and radially in the esophagus allow for simultaneous pressure readings spanning both sphincters and the interposed esophagus.

                                

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Literature review current through: Nov 2016. | This topic last updated: Thu Apr 02 00:00:00 GMT 2015.
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References
Top
  1. Clouse RE, Prakash C. Topographic esophageal manometry: an emerging clinical and investigative approach. Dig Dis 2000; 18:64.
  2. Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107:1865.
  3. Pandolfino JE, Kahrilas PJ, American Gastroenterological Association. AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005; 128:209.
  4. Ghosh SK, Pandolfino JE, Zhang Q, et al. Quantifying esophageal peristalsis with high-resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol 2006; 290:G988.
  5. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology 2008; 135:756.
  6. Sweis R, Anggiansah A, Wong T, et al. Normative 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; 23:509.
  7. Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001; 49:145.
  8. Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015; 27:160.
  9. Pandolfino JE, El-Serag HB, Zhang Q, et al. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 2006; 130:639.
  10. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 2008; 22:601.
  11. Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology 2006; 130:334.
  12. Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol 1991; 261:G677.
  13. Fox M, Hebbard G, Janiak P, et al. High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil 2004; 16:533.
  14. Pohl D, Ribolsi M, Savarino E, et al. Characteristics of the esophageal low-pressure zone in healthy volunteers and patients with esophageal symptoms: assessment by high-resolution manometry. Am J Gastroenterol 2008; 103:2544.
  15. Ghosh SK, Pandolfino JE, Kwiatek MA, Kahrilas PJ. Oesophageal peristaltic transition zone defects: real but few and far between. Neurogastroenterol Motil 2008; 20:1283.
  16. Kwiatek MA, Nicodème F, Pandolfino JE, Kahrilas PJ. Pressure morphology of the relaxed lower esophageal sphincter: the formation and collapse of the phrenic ampulla. Am J Physiol Gastrointest Liver Physiol 2012; 302:G389.
  17. Pandolfino JE, Leslie E, Luger D, et al. The contractile deceleration point: an important physiologic landmark on oesophageal pressure topography. Neurogastroenterol Motil 2010; 22:395.
  18. Ghosh SK, Pandolfino JE, Rice J, et al. Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls. Am J Physiol Gastrointest Liver Physiol 2007; 293:G878.
  19. Lin Z, Kahrilas PJ, Roman S, et al. Improving the Integrated Relaxation Pressure (IRP) cutoff value for the diagnosis of achalasia using a classification and regression tree (CART) model (abstract). Gastroenterology 2012; 142(Suppl 1):S281.
  20. Behar J, Biancani P. Pathogenesis of simultaneous esophageal contractions in patients with motility disorders. Gastroenterology 1993; 105:111.
  21. Roman S, Lin Z, Pandolfino JE, Kahrilas PJ. Distal contraction latency: a measure of propagation velocity optimized for esophageal pressure topography studies. Am J Gastroenterol 2011; 106:443.
  22. Xiao Y, Kahrilas PJ, Kwasny MJ, et al. High-resolution manometry correlates of ineffective esophageal motility. Am J Gastroenterol 2012; 107:1647.
  23. Kumar N, Porter RF, Chanin JM, Gyawali CP. Analysis of intersegmental trough and proximal latency of smooth muscle contraction using high-resolution esophageal manometry. J Clin Gastroenterol 2012; 46:375.
  24. Roman S, Lin Z, Kwiatek MA, et al. Weak peristalsis in esophageal pressure topography: classification and association with Dysphagia. Am J Gastroenterol 2011; 106:349.
  25. Porter RF, Kumar N, Drapekin JE, Gyawali CP. Fragmented esophageal smooth muscle contraction segments on high resolution manometry: a marker of esophageal hypomotility. Neurogastroenterol Motil 2012; 24:763.
  26. Fox MR, Bredenoord AJ. Oesophageal high-resolution manometry: moving from research into clinical practice. Gut 2008; 57:405.
  27. Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol 2008; 42:627.
  28. Pandolfino JE, Kwiatek MA, Nealis T, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008; 135:1526.
  29. Scherer JR, Kwiatek MA, Soper NJ, et al. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg 2009; 13:2219.
  30. Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 2012; 24 Suppl 1:57.
  31. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 2009; 21:796.
  32. Pandolfino JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology 2011; 141:469.
  33. Pandolfino JE, Ghosh SK, Rice J, et al. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol 2008; 103:27.
  34. Salvador R, Costantini M, Zaninotto G, et al. The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg 2010; 14:1635.
  35. Pratap N, Reddy DN. Can achalasia subtyping by high-resolution manometry predict the therapeutic outcome of pneumatic balloon dilatation?: author's reply. J Neurogastroenterol Motil 2011; 17:205.
  36. Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology 2013; 145:954.
  37. Krishnan K, Lin CY, Keswani R, et al. Endoscopic ultrasound as an adjunctive evaluation in patients with esophageal motor disorders subtyped by high-resolution manometry. Neurogastroenterol Motil 2014; 26:1172.
Topic Outline

GRAPHICS