New Developments in Esophageal Motility Testing
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Purpose of review
The purpose of this review is to present the latest developments in esophageal motility testing and summarize the current paradigm of esophageal motility disorders.
While high-resolution esophageal pressure topography interpreted according to the Chicago Classification represents the gold standard to evaluate esophageal motility, recent studies highlight the additional value of novel manometric applications. Novel applications include provocative measures to assess for obstructive physiology at the esophagogastric junction (EGJ), esophageal peristaltic reserve, and rumination and supragastric belching disorders. Furthermore, high-resolution impedance manometry provides assessment of bolus flow in relation to pressure changes. Distinct from manometry, the endolumenal functional lumen imaging probe examines esophageal motor response to distension to provide complementary and alternative data with regard to EGJ function and esophageal body motor function. Barium esophagram with timed swallow and barium tablet continues to be an important esophageal motility test. Furthermore, current use of multichannel intraluminal impedance-pH monitoring extends beyond reflux monitoring to measure reflux clearance and esophageal epithelial integrity.
The diagnostic armamentarium for esophageal motility disorders has expanded tremendously to include a multitude of sophisticated tools. Advancements in diagnostic technology and understanding of esophageal physiology have shifted the field to more precisely characterize esophageal motility and guide phenotype-driven management.
KeywordsEsophageal manometry pH monitoring FLIP Mucosal impedance Barium esophagram Esophageal physiology EGJ obstruction
Functional luminal imaging probe
Multichannel intraluminal impedance-pH
Esophageal pressure topography
Integrated relaxation pressure
Lower esophageal sphincter
Per-oral endoscopy myotomy
American Gastroenterological Association
High-resolution impedance manometry
Esophageal impedance integral
Proton pump inhibitor
Repetitive antegrade contractions
Repetitive retrograde contractions
Mean nocturnal baseline impedance
Gastroesophageal reflux disease
Post-reflux swallow-induced peristaltic wave
RY, GTF, PMK: literature review, manuscript drafting, and final review.
Compliance with Ethical Standards
Conflict of Interest
Rena Yadlapati is a consultant for Ironwood Pharmaceuticals, Diversatek, and Medtronic, and received grants from NIHNIDDK and the American College of Gastroenterology.
Glenn Furuta reports grants from NIHNIDDK and personal fees from Shire, outside the submitted workIn addition; Dr. Furuta has a patent (EnteroTrack) licensed, and a patent (UpToDate) with royalties paid. Paul Menard-Katcher declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Disclosures/Declaration of Funding
RY: Consultant for Ironwood, Diversatek Healthcare, Medtronic; supported by NIH R01 DK092217 (Pandolfino), and ACG Junior Faculty Development Award (Yadlapati).
GTF: NIH 1K24DK100303, consultant for Shire, co-founder of EnteroTrack, royalties from UpToDate.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as • Of importance •• Of major importance
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