What is the interpretation of esophageal manometry results?

From the Guidelines

Esophageal manometry results are interpreted based on the diagnosis of dysphagia, particularly when a mechanical obstruction cannot be found, and are useful in establishing a diagnosis of achalasia or other motility disorders.

Key Points to Consider

• High-resolution manometry (HRM) is superior to standard manometry in terms of reproducibility, speed of performance, and ease of interpretation, as stated in the British Society of Gastroenterology guidelines 1.
• The addition of impedance to HRM can be a helpful adjunct to visualize bolus movement and peristalsis effectiveness, although its utility in clinical practice and impact on therapeutic decision making is not yet clear 1.
• Indications for esophageal manometry include establishing the diagnosis of dysphagia when a mechanical obstruction cannot be found, placement of intraluminal devices, and preoperative assessment of patients being considered for antireflux surgery, especially if achalasia is suspected 1.
• Manometry is not indicated for making or confirming a suspected diagnosis of gastroesophageal reflux disease or as the initial test for chest pain or other esophageal symptoms due to low specificity of findings 1.
• The American Gastroenterological Association medical position statement provides recommendations for the clinical use of esophageal manometry, including indications, possible indications, and situations where manometry is not indicated 1.

From the Research

Interpretation of Esophageal Manometry Results

The interpretation of esophageal manometry results is a complex process that has been improved with the introduction of high-resolution esophageal manometry (HRM) and the Chicago Classification 2, 3. The Chicago Classification is a standardized scheme for interpreting esophageal motility disorders, and it has been updated several times to reflect new advances in the field 3, 4.

Key Components of Interpretation

The interpretation of esophageal manometry results involves several key components, including:

• The use of HRM to obtain detailed measurements of esophageal pressure and motility patterns 2, 3
• The application of the Chicago Classification to diagnose esophageal motility disorders 2, 3, 4
• The use of metric data from esophageal pressure topography (EPT) plots to synthesize an esophageal motility diagnosis 5
• The performance of a standard HRM protocol, including a baseline phase and a series of wet swallows in the supine or reclined position 5

Clinical Applications

Esophageal manometry has several clinical applications, including:

• The diagnosis of esophageal motility disorders, such as achalasia and gastroesophageal reflux disease (GERD) 2, 3, 4
• The evaluation of patients with dysphagia and other esophageal symptoms 2, 4
• The assessment of esophageal contractile reserve through provocative maneuvers during HRM 4
• The use of combined high-resolution impedance technology to assess bolus transit and postprandial responses 5

Quality Measures

The quality of esophageal manometry results can be ensured by following established quality measures, including:

• Competency in performing and interpreting esophageal manometry 6
• Assessment before the esophageal manometry procedure 6
• Standardization of the esophageal manometry procedure itself 6
• Interpretation of data using established criteria, such as the Chicago Classification 6