Digestive Diseases and Sciences

, Volume 63, Issue 12, pp 3178–3186 | Cite as

Utility of Esophageal High-Resolution Manometry in Clinical Practice: First, Do HRM

  • Ishita Dhawan
  • Brendon O’Connell
  • Amit Patel
  • Ron Schey
  • Henry P. Parkman
  • Frank FriedenbergEmail author
Mentored Reviews


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.


Esophageal high-resolution manometry (HRM) Gastroesophageal reflux disease (GERD) Antireflux surgery (ARS) Chicago classification 



Crural diaphragm


Contractile deceleration point


Distal contractile integral


Distal esophageal spasm


Distal latency


Esophagogastric junction


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.

Author’s contribution

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ishita Dhawan
    • 1
  • Brendon O’Connell
    • 2
  • Amit Patel
    • 2
  • Ron Schey
    • 3
  • Henry P. Parkman
    • 3
  • Frank Friedenberg
    • 3
    Email author
  1. 1.Department of Medicine, Pennsylvania HospitalUniversity of Pennsylvania Health SystemPhiladelphiaUSA
  2. 2.Division of Gastroenterology, Durham Veterans Affairs Medical CenterDuke University School of MedicineDurhamUSA
  3. 3.Gastroenterology Section, Department of Medicine, Lewis Katz School of MedicineTemple University School of MedicinePhiladelphiaUSA

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