Abstract
High resolution manometry (HRM), developed from conventional manometry, is the gold
standard for assessment of esophageal motor function worldwide. The Chicago Classification,
now in its fourth iteration, is the modern standard for HRM categorization of esophageal
motility disorders. The HRM protocol has expanded from the original 10 supine swallow
standard, to include upright swallows, and provocative maneuvers such as multiple
rapid swallows, rapid drink challenge and standardized test meal. Impedance has been
incorporated into HRM for visualization of bolus clearance. Futhermore, barium radiography
and functional lumen imaging probe complement HRM when evidence of esophagogastric
junction obstruction is inconclusive. The biggest impact of HRM is in the improved
diagnosis and subtyping of achalasia spectrum disorders, with implications on management.
Spastic disorders and absent contractility are better characterized. Within the reflux
spectrum, HRM provides definition of morphology and tone of the esophagogastric junction,
and assesses integrity of esophageal body peristalsis, which have pathophysiologic
implications for reflux and its clearance. HRM provides characterization of behavioral
disorders such as supragastric belching and rumination syndrome, which can mimic reflux
disease. Thus, HRM has revolutionized the evaluation of esophageal motor function,
and has expanded the utility of esophageal manometry in clinical practice.
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Article info
Publication history
Published online: May 11, 2021
Accepted:
April 8,
2021
Received:
January 20,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
