Abstract
Patients with esophageal symptoms potentially associated to esophageal motor disorders
such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most
frequent reasons for referral to gastroenterological evaluation. The utility of esophageal
manometry in clinical practice is: (1) to accurately define esophageal motor function,
(2) to identify abnormal motor function, and (3) to establish a treatment plan based
on motor abnormalities. With this in mind, in the last decade, investigations and
technical advances, with the introduction of high-resolution esophageal manometry,
have enhanced our understanding and management of esophageal motility disorders. The
following recommendations were developed to assist physicians in the appropriate use
of esophageal manometry in modern patient care. They were discussed and approved after
a comprehensive review of the medical literature pertaining to manometric techniques
and their recent application. This position statement created under the auspices of
the Gruppo Italiano di Studio per la Motilità dell’Apparato Digerente (GISMAD), Società
Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE) and Associazione Italiana
Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help
clinicians in applying manometric studies in the most fruitful manner within the context
of their patients with esophageal symptoms.
Keywords
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References
- Granger D.N. Granger J.P. Motor function of the pharynx, esophagus, and its sphincters. Morgan & Claypool Publishers Life Sciences, 2011
- Anatomy and physiology of the esophageal body.Diseases of the Esophagus. 2012; 25: 292-298
- Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape?.American Journal of Physiology. 1997; 272: G1509-G1517
- Neuronal pathways and transmission to the lower esophageal sphincter of the guinea Pig.Gastroenterology. 1998; 115: 661-671
- Manual of high resolution esophageal manometry.1st edition. UNI-MED, Bremen2014
- Extrinsic sensory afferent nerves innervating the gastrointestinal tract.Physiology of the gastrointestinal tract – fourth edition. Elsevier AP, 2006
- Physiology of normal esophageal motility.Journal of Clinical Gastroenterology. 2008; 42: 610-619
- Regional gradient of initial inhibition and refractoriness in esophageal smooth muscle.Gastroenterology. 1985; 89: 843-851
- Responses of the human esophagus to paired swallows.Gastroenterology. 1987; 92: 643-650
- Effect of time interval between swallows on esophageal peristalsis.American Journal of Physiology. 1980; 238: G485-G490
- Origin and modulation of circular smooth muscle layer contractions in the porcine esophagus.Neurogastroenterology and Motility. 2012; 24 (e355): 779-789
- Regionally dependent neuromuscular functions of motilin and 5-HT(4) receptors in human isolated esophageal body and gastric fundus.Neurogastroenterology and Motility. 2014; 26: 1311-1322
- Regional differences in the response of feline esophageal smooth muscle to stretch and cholinergic stimulation.American Journal of Physiology: Gastrointestinal and Liver Physiology. 2001; 281 (G-1460-7)
- A wave of inhibition precedes primary peristaltic contractions in the human esophagus.Gastroenterology. 1992; 103: 876-882
- Longitudinal muscle dysfunction in achalasia esophagus and its relevance.Journal of Neurogastroenterology and Motility. 2013; 19: 126-136
- Disruption of primary and secondary esophageal peristalsis by afferent stimulation.American Journal of Physiology: Gastrointestinal and Liver Physiology. 2000; 279: G255-G261
- Objective definition and detection of transient lower esophageal sphincter relaxation revisited: is there room for improvement?.Neurogastroenterology and Motility. 2012; 24: 54-60
- Improved infusion system for intraluminal esophageal manometry.Gastroenterology. 1977; 73: 23-27
- A new technique for continuous sphincter pressure measurement.Gastroenterology. 1976; 71: 263-267
- Normative values in esophageal high-resolution manometry.Neurogastroenterology and Motility. 2015; 27: 175-187
- Application of topographical methods to clinical esophageal manometry.American Journal of Gastroenterology. 2000; 95: 2720-2730
- Combined multichannel intraluminal impedance and manometry testing.Digestive and Liver Disease. 2008; 40: 167-173
- Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease.Alimentary Pharmacology and Therapeutics. 2011; 34: 476-486
- Functional aspects of distal oesophageal spasm: the role of onset velocity and contraction amplitude on bolus transit.Digestive and Liver Disease. 2012; 44: 569-575
- Oesophageal high-resolution manometry: moving from research into clinical practice.Gut. 2008; 57: 405-423
- Multiple rapid swallowing: a complementary test during standard oesophageal manometry.Neurogastroenterology and Motility. 2009; 21: 718-741
- The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery.Surgical Endoscopy. 2012; 26: 3401-3407
- Usefulness of low- and high-volume multiple rapid swallowing during high-resolution manometry.Digestive and Liver Disease. 2015; 47: 103-107
- The Chicago Classification of esophageal motility disorders, v3.0.Neurogastroenterology and Motility. 2015; 27: 160-174
- Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD.Neurogastroenterology and Motility. 2016; 28: 243-250
- Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry.Neurogastroenterology and Motility. 2011; 23 (509-e198)
- Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high-resolution manometry.Neurogastroenterology and Motility. 2014; 26: 215-228
- Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease.Neurogastroenterology and Motility. 2011; 23 (517-e200)
- Investigation of dysphagia after antireflux surgery by high-resolution manometry: impact of multiple water swallows and a solid test meal on diagnosis, management, and clinical outcome.Clinical Gastroenterology and Hepatology. 2015; 13: 1575-1583
- Classification of oesophageal motility abnormalities.Gut. 2001; 49: 145-151
- Esophageal manometry: assessment of interpreter consistency.Clinical Gastroenterology and Hepatology. 2005; 3: 218-224
- High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD.American Journal of Gastroenterology. 2007; 102: 1056-1063
- Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?.Neurogastroenterology and Motility. 2015; 27: 1423-1431
- Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD.Neurogastroenterology and Motility. 2015; 27: 1175-1182
- Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux.Gastroenterology. 2006; 130: 334-340
- Impaired deglutitive EGJ relaxation in clinical esophageal manometry: a quantitative analysis of 400 patients and 75 controls.American Journal of Physiology: Gastrointestinal and Liver Physiology. 2007; 293: G878-G885
- Achalasia: a systematic review.JAMA. 2015; 313: 1841-1852
- The impact of Heller myotomy on integrated relaxation pressure in esophageal achalasia.Journal of Gastrointestinal Surgery. 2016; 20: 125-131
- Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model.Neurogastroenterology and Motility. 2012; 24: e356-e363
- Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes.Gastroenterology. 2011; 141: 469-475
- Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry.Diseases of the Esophagus. 2015; 28: 711-719
- Ineffective esophageal motility does not equate to GERD.American Journal of Gastroenterology. 2003; 98: 715-717
- Systematic analysis of esophageal pressure topography in high-resolution manometry of 68 normal volunteers.Diseases of the Esophagus. 2013; 26: 651-660
- Normal values for solid-state esophageal high-resolution manometry in a European population; an overview of all current metrics.Neurogastroenterology and Motility. 2014; 26: 654-659
- The effect of a sitting vs supine posture on normative esophageal pressure topography metrics and Chicago Classification diagnosis of esophageal motility disorders.Neurogastroenterology and Motility. 2012; 24: e509-e516
- Variant parameter values-as defined by the Chicago Criteria-produced by ManoScan and a new system with Unisensor catheter.Neurogastroenterology and Motility. 2015; 27: 188-194
- Inter-rater and inter-device agreement for the diagnosis of primary esophageal motility disorders based on Chicago Classification between solid-state and water-perfused HRM system a prospective, randomized, double blind, crossover study.in: Digestive Disease Week 2014, Chicago2014
- Normal values for esophageal high-resolution manometry.Neurogastroenterology and Motility. 2013; 25 (762-e579)
- Water-perfused esophageal high-resolution manometry: normal values and validation.American Journal of Physiology: Gastrointestinal and Liver Physiology. 2014; 306: G491-G495
- Normative data of high-resolution impedance manometry in the Chinese population.Journal of Gastroenterology and Hepatology. 2013; 28: 1611-1615
- Normal esophageal high-resolution manometry and impedance values in the supine and sitting positions in the population of Northern China.Diseases of the Esophagus. 2014; ([Epub ahead of print])
- Normal esophageal pressure topography metrics for data derived from the Sandhill-Unisensor high-resolution manometry assembly in supine and sitting positions.Neurogastroenterology and Motility. 2015; 27: 285-292
- Normal values of esophageal motility after antireflux surgery; a study using high-resolution manometry.Neurogastroenterology and Motility. 2015; 27: 929-935
- The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.American Journal of Gastroenterology. 2006; 101 (quiz 43): 1900-1920
- Dysmotility and reflux disease.Current Opinion in Otolaryngology & Head and Neck Surgery. 2013; 21: 548-556
- Defining esophageal landmarks, gastroesophageal reflux disease, and Barrett's esophagus.Annals of the New York Academy of Sciences. 2013; 1300: 278-295
- Characteristics of gastro-esophageal reflux episodes in Barrett's esophagus, erosive esophagitis and healthy volunteers.Neurogastroenterology and Motility. 2010; 22 (1061-e280)
- Reflux patterns in patients with short-segment Barrett's oesophagus: a study using impedance-pH monitoring off and on proton pump inhibitor therapy.Alimentary Pharmacology and Therapeutics. 2009; 30: 508-515
- Esophageal manometry and ambulatory 24-hour pH monitoring in patients with short and long segment Barrett's esophagus.American Journal of Gastroenterology. 1998; 93: 916-919
- Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy.American Journal of Gastroenterology. 2010; 105: 1053-1061
- NERD: an umbrella term including heterogeneous subpopulations.Nature Reviews Gastroenterology & Hepatology. 2013; 10: 371-380
- AGA technical review on the clinical use of esophageal manometry.Gastroenterology. 2005; 128: 209-224
- Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders.Neurogastroenterology and Motility. 2014; 26: 353-360
- Esophageal peristaltic dysfunction in peptic esophagitis.Gastroenterology. 1986; 91: 897-904
- Characteristics of the esophageal low-pressure zone in healthy volunteers and patients with esophageal symptoms: assessment by high-resolution manometry.American Journal of Gastroenterology. 2008; 103: 2544-2549
- Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia.Neurogastroenterology and Motility. 2012; 24: e364-e372
- Functional heartburn has more in common with functional dyspepsia than with non-erosive reflux disease.Gut. 2009; 58: 1185-1191
- The role of nonacid reflux in NERD: lessons learned from impedance-pH monitoring in 150 patients off therapy.American Journal of Gastroenterology. 2008; 103: 2685-2693
- Esophageal motility abnormalities in gastroesophageal reflux disease.World Journal of Gastrointestinal Pharmacology and Therapeutics. 2014; 5: 86-96
- Esophageal testing: what we have so far.World Journal of Gastrointestinal Pathophysiology. 2016; 7: 72-85
- How reflux causes symptoms: reflux perception in gastroesophageal reflux disease.Best Practice & Research Clinical Gastroenterology. 2013; 27: 353-364
- Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients.Journal of Gastroenterology. 2012; 47: 159-168
- Functional heartburn and non-erosive reflux disease.Digestive Diseases. 2007; 25: 172-174
- The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease.Digestive and Liver Disease. 2011; 43: 542-547
- Transient lower esophageal sphincter relaxations: how many or how harmful?.American Journal of Gastroenterology. 2001; 96: 2529-2532
- Manometry vs. pH step-up.American Journal of Gastroenterology. 1991; 86: 1280-1282
- Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode?.American Journal of Gastroenterology. 1990; 85: 1463-1467
- Value of subject height in predicting lower esophageal sphincter location.American Journal of Diseases of Children. 1991; 145: 1424-1427
- Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study.Gastroenterology. 2001; 121: 5-14
- Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication.British Journal of Surgery. 1990; 77: 43-45
- EAES recommendations for the management of gastroesophageal reflux disease.Surgical Endoscopy. 2014; 28: 1753-1773
- Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel.Journal of the American College of Surgeons. 2013; 217: 586-597
- Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility.Journal of Gastrointestinal Surgery. 1997; 1 (discussion 8): 301-308
- Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve.American Journal of Gastroenterology. 2013; 108: 1706-1712
- The diagnosis of gastro-esophageal reflux disease cannot be made with barium esophagograms.Neurogastroenterology and Motility. 2015; 27: 195-200
- Current diagnosis and management of the rumination syndrome.Journal of Clinical Gastroenterology. 2014; 48: 478-483
- Eosinophilic oesophagitis: from physiopathology to treatment.Digestive and Liver Disease. 2013; 45: 871-878
- Achalasia with dense eosinophilic infiltrate responds to steroid therapy.Clinical Gastroenterology and Hepatology. 2011; 9: 1104-1106
- High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia: a randomized multicenter study.American Journal of Gastroenterology. 2016; 111: 372-380
- Achalasia: a new clinically relevant classification by high-resolution manometry.Gastroenterology. 2008; 135: 1526-1533
- Outcomes of treatment for achalasia depend on manometric subtype.Gastroenterology. 2013; 144 (quiz e13-4): 718-725
- Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first over 100 patients with short-term follow-up.Surgical Endoscopy. 2016; ([Epub ahead of print])
- Peroral endoscopic myotomy (POEM) for esophageal achalasia.Endoscopy. 2010; 42: 265-271
- Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years.Gut. 2015;
- Peroral endoscopic myotomy: an evolving treatment for achalasia.Nature Reviews Gastroenterology & Hepatology. 2015; 12: 410-426
- Comparison of pseudoachalasia and achalasia.American Journal of Medicine. 1987; 82: 439-446
- Characterization of idiopathic esophagogastric junction outflow obstruction.Neurogastroenterology and Motility. 2015; 27: 1310-1316
- Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites.Gastroenterology. 1977; 72: 23-27
- Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders.Clinical Gastroenterology and Hepatology. 2013; 11 (e2): 1115-1121
- International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video).Gastrointestinal Endoscopy. 2015; 81: 1170-1177
- Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients.American Journal of Gastroenterology. 2004; 99: 1011-1019
- Nutcracker oesophagus: a double-blind, placebo-controlled, cross-over study of the effects of lansoprazole.Alimentary Pharmacology and Therapeutics. 2003; 18: 1129-1135
- Esophageal spasm: demographic, clinical, radiographic, and manometric features in 108 patients.Diseases of the Esophagus. 2012; 25: 214-221
- Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience.Annals of Surgery. 2008; 248: 986-993
- Life expectancy, complications, and causes of death in patients with achalasia: results of a 33-year follow-up investigation.European Journal of Gastroenterology and Hepatology. 2008; 20: 956-960
- Esophagogastric junction morphology assessment by high resolution manometry in obese patients candidate to bariatric surgery.International Journal of Surgery. 2015; ([Epub ahead of print])
- High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events.Obesity Surgery. 2016; ([Epub ahead of print])
- Effects of omega-loop bypass on esophagogastric junction function.Surgery for Obesity and Related Diseases. 2016; 12: 62-69
- Noncardiac chest pain: epidemiology, natural course and pathogenesis.Journal of Neurogastroenterology and Motility. 2011; 17: 110-123
- Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota.Gastroenterology. 1997; 112: 1448-1456
- Non-cardiac chest pain: prevalence, risk factors, impact and consulting—a population-based study.Alimentary Pharmacology and Therapeutics. 2003; 17: 1115-1124
- The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain.Gastroenterology. 1998; 115: 42-49
- The effect of a therapeutic trial of high-dose rabeprazole on symptom response of patients with non-cardiac chest pain: a randomized, double-blind, placebo-controlled, crossover trial.Alimentary Pharmacology and Therapeutics. 2005; 22: 547-555
- Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients.Annals of Internal Medicine. 1987; 106: 593-597
- Assessment of oesophageal motor function in patients with dysphagia or chest pain – the Clinical Outcomes Research Initiative experience.Alimentary Pharmacology and Therapeutics. 2003; 18: 1083-1089
- Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain.Gastroenterology. 1990; 99: 1257-1264
- High resolution manometry patterns distinguish acid sensitivity in non-cardiac chest pain.Neurogastroenterology and Motility. 2011; 23: 1066-1072
- Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters.Neurogastroenterology and Motility. 2014; 26: 139-148
- Lactulose breath test to assess oro-cecal transit delay and estimate esophageal dysmotility in scleroderma patients.Seminars in Arthritis and Rheumatism. 2013; 42: 522-529
- Gastrointestinal involvement in systemic sclerosis.Presse Médicale. 2014; 43: e279-e291
- Loss of peristaltic reserve, determined by multiple rapid swallows is the most frequent esophageal motility abnormality in patients with systemic sclerosis.Clinical Gastroenterology and Hepatology. 2016; ([Epub ahead of print])
- Gastrointestinal motility disorder assessment in systemic sclerosis.Rheumatology. 2013; 52: 1095-1100
- Gastroesophageal reflux and pulmonary fibrosis in scleroderma: a study using pH-impedance monitoring.American Journal of Respiratory and Critical Care Medicine. 2009; 179: 408-413
- Assessment of esophageal involvement in systemic sclerosis and morphea (localized scleroderma) by clinical, endoscopic, manometric and pH metric features: a prospective comparative hospital based study.BMC Gastroenterology. 2015; 15: 24
- Esophageal involvement in juvenile localized scleroderma: a pilot study.Clinical and Experimental Rheumatology. 2007; 25: 786-789
- Esophageal dysmotility associated with systemic sclerosis: a high-resolution manometry study.Diseases of the Esophagus. 2011; 24: 299-304
- Manometric assessment of esophageal motility in patients with primary Sjogren's syndrome.Rheumatology International. 2005; 25: 246-249
- Oesophageal function assessed by high-resolution manometry in patients with diabetes and inadequate glycaemic control.Diabetic Medicine. 2014; 31: 1452-1459
- American Gastroenterological Association medical position statement: clinical use of esophageal manometry.Gastroenterology. 2005; 128: 207-208
- High-resolution manometry studies are frequently imperfect but usually still interpretable.Clinical Gastroenterology and Hepatology. 2011; 9: 1050-1055
- The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia.Journal of Gastrointestinal Surgery. 2010; 14: 1635-1645
Article info
Publication history
Published online: July 18, 2016
Accepted:
June 21,
2016
Received:
April 18,
2016
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
