How useful is esophageal high resolution manometry in diagnosing gastroesophageal junction disruption: causes affecting this disruption and its relationship with manometric alterations and gastroesophageal reflux

Abstract

Increased age, overweight and central obesity pose a higher risk of GEJ type III (hiatal hernia). The greater disruption of the GEJ is associated with lower resting pressure, esophageal shortening, and higher acid exposure in the pH-monitoring.

Esophagogastric junction and esophageal body contraction metrics on high‐resolution manometry predict esophageal acid burden

“…31 Further, EGJ morphology has now been subtyped using HRM into 3 categories based on overlap or separation between the intrinsic LES and the crural diaphragm, 3 and esophageal reflux burden is higher with more extreme separation between these 2 anatomic structures. 32 Our findings support these concepts. A hypotensive EGJ escalates esophageal reflux burden, and surgical management leads to a better symptom outcome compared to medical management, especially when esophageal reflux burden is high in this setting.…”

“…The use of EGJ‐CI in defining hypomotility of the EGJ has been enhanced by demonstration of elevated reflux burden when EGJ‐CI is low, and improvement in EGJ‐CI when antireflux surgery is performed . Further, EGJ morphology has now been subtyped using HRM into 3 categories based on overlap or separation between the intrinsic LES and the crural diaphragm, and esophageal reflux burden is higher with more extreme separation between these 2 anatomic structures . Our findings support these concepts.…”

How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease

“…EGJ was classified depending on the separation between the LES and crural diaphragm: type I (normal) ＜ 1 cm, type II be-tween 1-2 cm, and type III (hiatal hernia) when the distance is over 2 cm. 5,19 End expiratory EGJ pressure was measured while at rest in both positions. Four seconds integrated relaxation pressure (IRP-4s) was measured using the automated analysis tool in Mano View.…”

“…[1][2][3][4][5][6] It nevertheless involves some challenges such as determining the optimal protocol for HRM in clinical practice. [7][8][9] The test is usually performed in the supine position.…”

Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection?

“…Esophageal high-resolution manometry (HRM) represents an unquestionable advance in esophageal manometry and allows a better characterization of EMD and esophagogastric junction (EGJ) morphology (9). The Chicago classifications include the new data that HRM provides for the study of EMD (10).…”