Utility of Esophageal High-Resolution Manometry in Clinical Practice: First, Do HRM
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Esophageal high-resolution manometry (HRM) has advanced the understanding of esophageal motor function and the ability to diagnose and manage disorders of esophageal motility. In this review, we describe the indications for and the technical performance of HRM. The Chicago classification of esophageal motor function, now in its third iteration, streamlines and standardizes the nomenclature and basic interpretation of HRM data depicted as Clouse topographic plots. In clinical practice, HRM is an important diagnostic test for patients with dysphagia as well as patients with suspected gastroesophageal reflux disease (GERD), particularly in those patients with a suboptimal symptomatic response to antisecretory therapy. HRM can support diagnoses such as achalasia, as well as provide evidence for behavioral disorders such as rumination syndrome or supragastric belching with the assistance of postprandial HRM with impedance. Further, the GERD classification of motor function introduces a three-part hierarchical evaluation of esophageal motor function in GERD, highlighting the value of assessment of esophageal contractile reserve through provocative maneuvers during HRM such as multiple rapid swallows.
KeywordsEsophageal high-resolution manometry (HRM) Gastroesophageal reflux disease (GERD) Antireflux surgery (ARS) Chicago classification
Contractile deceleration point
Distal contractile integral
Distal esophageal spasm
EGJ outflow obstruction
Esophageal pressure topography
Gastroesophageal reflux disease
High-resolution esophageal manometry
High-resolution esophageal manometry with impedance
Ineffective esophageal motility
Integrated relaxation pressure
Lower esophageal sphincter
Respiratory inversion point
Upper esophageal sphincter
We would like to thank Rahul Kataria, a fellow in the section of Gastroenterology for contributing the manometry imaging.
Ishita Dhawan, MD, is a resident in the Department of Internal Medicine at Pennsylvania Hospital, and prepared and edited the manuscript. Brendon O’Connell, MD, is a fellow in the Division of Gastroenterology at Duke University School of Medicine and the Durham Veterans Affairs Medical Center, and prepared and edited the manuscript. Amit Patel, MD, is an assistant professor of Medicine in the Division of Gastroenterology at Duke University School of Medicine and the Durham Veterans Affairs Medical Center, and prepared and edited the manuscript. Ron Schey, MD, is a professor in the Section of Gastroenterology and provided critical revisions of the manuscript. Henry Parkman, MD, is a professor in the Section of Gastroenterology and provided critical revisions of the manuscript. Frank Friedenberg, MD MS, is Chief of Gastroenterology and Hepatology, and prepared and edited the manuscript.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
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