High resolution manometry
- Peter J Kahrilas, MD
Peter J Kahrilas, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
- John E Pandolfino, MD
John E Pandolfino, MD
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
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) . (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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- HIGH RESOLUTION MANOMETRY (HRM) WITH ESOPHAGEAL PRESSURE TOPOGRAPHY (EPT)
- - Pressure topography landmarks
- Anatomic sphincters
- Contractile segments
- Transition zone
- Contractile deceleration point (CDP)
- - Novel EPT metrics
- Integrated relaxation pressure (IRP)
- Distal latency (DL)
- Distal contractile integral (DCI)
- Contraction vigor
- Contraction pattern
- Pressurization patterns
- CLASSIFICATION OF MOTILITY DISORDERS BY ESOPHAGEAL PRESSURE TOPOGRAPHY (EPT)
- Stepwise approach to EPT analysis
- - Step 1: Assess the EGJ
- - Step 2: Characterize esophageal contractility
- - Step 3: Characterize pressurization patterns, if present
- EPT criteria for motility disorder subtypes
- - Achalasia
- - EGJ outflow obstruction
- - Major disorders of peristalsis
- Absent contractility
- Distal esophageal spasm (DES)
- Hypercontractile (jackhammer) esophagus
- - Minor disorders of peristalsis
- Ineffective esophageal motility (IEM)
- Fragmented peristalsis
- SUMMARY AND RECOMMENDATIONS