High-Resolution Manometry—Observations After 15 Years of Personal Use—Has Advancement Reached a Plateau?

Abstract

Purpose of Review In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau. Recent Findings HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Summary Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.

Why so Many Patients With Dysphagia Have Normal Esophageal Function Testing

“…Majority of the patients have symptoms when swallowing solid rather than the liquid bolus. 85 It is likely that the wall stress and strain values achieved during liquid bolus transit are not high enough to produce symptoms, and not representative of what happens during solid bolus swallow. We believe that dysphagia related to the bolus flowing through a narrow lumen esophagus is analogous to the dyspnea sensation experienced by patients with bronchospasm (air flowing through a narrow trachea-bronchial tree).…”

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

“…The mainstay of testing has been manometry of the GI tract. The value of manometric tests is likely to be enhanced and facilitated with the evolution of more physiological and robust protocols incorporating combined technologies (eg, manometry‐impedance) as well as better interpretation of acquired data, and disease sub‐classification (27).…”

Evaluating the impact of position, volume, and consistency on high‐resolution esophageal manometry outcomes

“…The substance that was utilized as the solid bolus, and its size, also differs widely between studies. Some have argued that solid boluses are more sensitive for the diagnosis of esophageal motility disorders 6 . However, the exact thresholds for defining pathology for nonliquid boluses, or boluses conducted in a nonsupine position are not clear and studies which have attempted to define this have used the criteria designed for liquid swallows in a supine position.…”