Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers

Abstract

Background/AimsIncorporation of complementary and provocative test swallows to the high-resolution manometry (HRM) protocol offers potential to address limitations posed by HRM protocols that involve only a single swallow type. The aim of this study is to describe normal findings of a comprehensive HRM testing protocol performed on healthy asymptomatic volunteers. MethodsThirty healthy asymptomatic volunteers completed HRM with 5-mL liquid swallows in the supine position. They also completed 5-mL liquid swallows in the upright position, viscous swallows, solid test swallows, multiple rapid swallows, and a rapid drink challenge. HRM studies were analyzed via Chicago classification version 3.0. ResultsThe median (5th-95th percentiles) for integrated relaxation pressure (IRP) on supine swallows was 11 (4-16) mmHg; IRP was lower than supine on upright liquid 9 (0-17) mmHg, viscous 6 (0-15) mmHg, solid 9 (1-19) mmHg, multiple rapid swallows 3 (0-12) mmHg, and rapid drink challenge 5 (-3-12) mmHg; P < 0.005. While an "elevated" IRP value was observed on 1 to 2 test maneuvers in 8/30 (27%) subjects, all 30 subjects had an IRP value < 12 mmHg on at least one of the test maneuvers. ConclusionsNormal values and findings from a comprehensive HRM testing protocol are reported based on evaluation of 30 healthy asymptomatic volunteers. Isolated "abnormalities" of IRP and contractile parameters were observed in the majority (80%) of these asymptomatic subjects, while all subjects also had normal features observed. Thus, the definition of "normal" should be recalibrated to focus on the entirety of the study and not individual metrics.

Functional Lumen Imaging Probe Panometry Helps Identify Clinically Relevant Esophagogastric Junction Outflow Obstruction per Chicago Classification v4.0

“…In this study, using CCv4.0 diagnostic criteria, the RDC seemed useful to predict treatment outcomes, though more so using both RDC-IRP and PEP (compared with only RDC-IRP). Another technical consideration with defining EGJOO entirely on the basis of an elevated IRP is that this metric can be influenced by recording artefacts (24,25). Thus, as outlined in CCv4.0, using HRM study protocols with supine and upright swallows and incorporation of HRM pressurization patterns seems essential (1,3,26).…”

Contraction reserve in high resolution manometry is correlated with lower esophageal acid exposure time in patients with normal esophageal motility: A retrospective observational study

“…However, IEM has not been consistently related to GERD. It has also been observed in asymptomatic healthy populations and patients with physiological acid reflux [ 6 , 7 ]. Hence, in CCv4.0, patients with ineffective swallows of 50–70% are considered inconclusive for a diagnosis as IEM to further sift out clinically relevant IEM.…”