• Taher OmariEmail author


Esophageal manometry has been in use for physiological measurement and diagnostics for many years. Solid-state high-resolution manometry (HRM) offers the ability to record pressures from the upper esophageal sphincter to the stomach with fidelity and high spatial resolution, and this has led to the definition of new objective biomechanical measures that may guide clinical decision-making in relation to paediatric patients with typical gastroesophageal reflux (GER) disease symptoms. The most important application of HRM is for the preoperative investigation of children undergoing work-up for anti-reflux surgery. Whilst the performance of HRM can be challenging in younger children, HRM can be used to exclude achalasia as a cause of typical symptoms and can provide a range of information on esophageal biomechanics that may be informative for determining disease severity. This includes characterisation of esophageal peristalsis and esophagogastric junction (EGJ) barrier function, based upon EGJ hiatus hernia subtype morphology and EGJ contractility. HRM may potentially have a role for investigation of recurrent transit hold-up symptoms following anti-reflux surgery. Finally, HRM may differentiate GER disease from rumination syndrome.


Gastroesophageal reflux Esophageal motility High-resolution manometry Diagnosis Dysphagia 


  1. 1.
    Singendonk MMJ, Kritas S, Cock C, Ferris L, McCall L, Rommel N, et al. Applying the Chicago classification criteria of esophageal motility to a pediatric cohort: effects of patient age and size. Neurogastroenterol Motil. 2014;26(9):1333–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Kahrilas PJ, Bredenoord a J, Fox M, Gyawali CP, Roman S, Smout a JPM, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Mauritz FA, Conchillo JM, LWE VH, Siersema PD, CEJ S, RHJ H, et al. Effect and efficacy of laparoscopic fundoplication in children with GERD: The Dutch prospective, multicenter study. Surg Endosc Other Interv Tech. 2016;30:S49. Springer USGoogle Scholar
  4. 4.
    Martinucci I, de Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5(2):86–96.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chan WW, Haroian LR, Gyawali CP. Value of preoperative esophageal function studies before laparoscopic antireflux surgery. Surg Endosc Other Interv Tech. 2011;25:2943–9.CrossRefGoogle Scholar
  6. 6.
    Pandolfino JE, M a K, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526–33.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Patti MG. An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg. 2015;151(1):1–6.Google Scholar
  8. 8.
    Singhal V, Khaitan L. Preoperative evaluation of gastroesophageal reflux disease. Surg Clin North Am. 2015;95(3):615–27. Elsevier Inc;CrossRefPubMedGoogle Scholar
  9. 9.
    Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg. 2013;217(4):586–97. Elsevier Inc;CrossRefPubMedGoogle Scholar
  10. 10.
    Karamanolis GP, Sifrim D. Patients with refractory gastroesophageal reflux disease: diagnostic tools. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2013;26:6–10.Google Scholar
  11. 11.
    Andolfi C, Bonavina L, Kavitt RT, Konda VJ, Asti E, Patti MG. Su1151 importance of esophageal manometry and pH monitoring in the evaluation of patients with “Refractory GERD”. A multicenter study. Gastroenterology. 2016;150(4):S1205.CrossRefGoogle Scholar
  12. 12.
    Richter JE. How to manage refractory GERD. Nat Clin Pract Gastroenterol Hepatol. 2007;4(12):658–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Pyun J, Choi D, Lee L, Yoo K, Shim J. Achalasia previously diagnosed as gastroesophageal reflux. Pediatr Gastroenterol Hepatol Nutr. 2015;18(1):55–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Abdel Jalil AA, Castell DO. Ineffective Esophageal Motility (IEM): the old-new frontier in esophagology. Curr Gastroenterol Rep. 2015;18:1–7.CrossRefGoogle Scholar
  15. 15.
    Ribolsi M, Balestrieri P, Emerenziani S, Guarino MPL, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109(1):46–51. Nature Publishing GroupCrossRefPubMedGoogle Scholar
  16. 16.
    Simic AP, Skrobic OM, Gurski RR, Sljukic VM, Ivanovic NR, Pesko PM. Can different subsets of ineffective esophageal motility influence the outcome of nissen fundoplication? J Gastrointest Surg. 2014;18:1723–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Andolfi C, Vigneswaran Y, Kavitt RT, Herbella FA, Patti MG. Laparoscopic antireflux surgery: importance of patient’s selection and preoperative workup. J Laparoendosc Adv Surg Tech. 2016;27(2):101–5. doi: 10.1089/lap.2016.0322.CrossRefGoogle Scholar
  18. 18.
    Mello MD, Shriver a R, Li Y, Patel a, Gyawali CP. Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016;28:292–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Cock C, Besanko L, Kritas S, Burgstad CM, Thompson A, Heddle R, et al. Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry. Neurogastroenterol Motil. 2016;28:1890–901.CrossRefPubMedGoogle Scholar
  20. 20.
    Wang YT, Tai LF, Yazaki E, Jafari J, Sweis R, Tucker E, et al. Investigation of dysphagia after antireflux surgery by high-resolution manometry: impact of multiple water swallows and a solid test meal on diagnosis, management, and clinical outcome. Clin Gastroenterol Hepatol. 2015;13(9):1575–83. Elsevier, IncCrossRefPubMedGoogle Scholar
  21. 21.
    Mittal R, Holloway R, Penagini R, Blackshaw L, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109(2):601–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Omari T, Benninga M, Sansom L, Butler R, Dent J, Davidson G. Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal disease. J Pediatr. 2006;149:468–74.CrossRefPubMedGoogle Scholar
  23. 23.
    Sifrim D, Holloway R, Silny J, Tack J, Lerut A, Janssens J. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96(3):647–55.CrossRefPubMedGoogle Scholar
  24. 24.
    Pandolfino JE, Zhang QG, Ghosh SK, Han A, Boniquit C, Kahrilas PJ. Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry. Gastroenterology. 2006;131:1725–33.CrossRefPubMedGoogle Scholar
  25. 25.
    Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006 Mar;130(3):639–49.CrossRefPubMedGoogle Scholar
  26. 26.
    Del Grande LM, Herbella F a M, Bigatao AM, Abrao H, Jardim JR, Patti MG. Pathophysiology of gastroesophageal reflux in patients with chronic pulmonary obstructive disease is linked to an increased transdiaphragmatic pressure gradient and not to a defective esophagogastric barrier. J Gastrointest Surg. 2016;20:104–10.CrossRefPubMedGoogle Scholar
  27. 27.
    Roman S, Zerbib F, Belhocine K, Bruley Des Varannes S, Mion F. High resolution manometry to detect transient lower oesophageal sphincter relaxations: Diagnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria. Aliment Pharmacol Ther. 2011;34:384–93.CrossRefPubMedGoogle Scholar
  28. 28.
    Kwiatek MA, Pandolfino JE, Kahrilas PJ. 3D-high resolution manometry of the esophagogastric junction. Neurogastroenterol Motil. 2011 Nov;23(11):e461–9.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Nicodème F, Pandolfino JE, Lin Z, Xiao Y, Escobar G, Kahrilas PJ. Adding a radial dimension to the assessment of esophagogastric junction relaxation: validation studies of the 3D-eSleeve. Am J Physiol Gastrointest Liver Physiol. 2012;303(3):G275–80.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ. High-resolution manometry of the EGJ: An analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102:1056–63.CrossRefPubMedGoogle Scholar
  31. 31.
    E Souza MÂ, Nobre RA, Bezerra PC, Dos Santos AA, Sifrim D. Anatomical and functional deficiencies of the crural diaphragm in patients with esophagitis. Neurogastroenterol Motil. 2016;29:e12899.CrossRefGoogle Scholar
  32. 32.
    Weijenborg PW, van Hoeij FB, Smout a JPM, Bredenoord a J. Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil. 2015;27:293–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Tolone S, De Bortoli N, Marabotto E, de Cassan C, Bodini G, Roman S, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;27:1423–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Hoshino M, Srinivasan A, Mittal SK. High-resolution manometry patterns of lower esophageal sphincter complex in symptomatic post-fundoplication patients. J Gastrointest Surg. 2012;16:705–14.CrossRefPubMedGoogle Scholar
  35. 35.
    Yamamoto SR, Akimoto S, Hoshino M, Mittal SK. High-resolution manometry findings in symptomatic post-Nissen fundoplication patients with normal endoscopic configuration. Dis Esophagus. 2015;29:967–70.CrossRefPubMedGoogle Scholar
  36. 36.
    Jasper D, Freitas-Queiroz N, Hollenstein M, Misselwitz B, Layer P, Navarro-Rodriguez T, et al. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil. 2016;29:e12925.CrossRefGoogle Scholar
  37. 37.
    Gor P, Li Y, Munigala S, Patel a B a, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2015;29:820–8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Wang D, Patel a, Mello M, Shriver a, Gyawali CP. Esophagogastric junction contractile integral (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention. Neurogastroenterol Motil. 2016;28:639–46.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Nicodeme F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: Normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26(3):353–60.CrossRefPubMedGoogle Scholar
  40. 40.
    Dell’Acqua-Cassao B, Mardiros-Herbella FA, Farah JF, Bonadiman A, Silva LC, Patti MG. Outcomes of laparoscopic Nissen fundoplication in patients with manometric patterns of esophageal motility disorders. Am Surg. 2013;79:361–5.PubMedGoogle Scholar
  41. 41.
    Ribeiro M, Tercioti-júnior V, Souza-neto JC, Lopes LR, Morais DJ, Andreollo NA. Identification of preoperative risk factors for persistent postoperative dysphagia after laparoscopic antireflux surgery. Arq Bras Cir Dig. 2013;26(3):165–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Marjoux S, Roman S, Juget-Pietu F, Robert M, Poncet G, Boulez J, et al. Impaired postoperative EGJ relaxation as a determinant of post laparoscopic fundoplication dysphagia: a study with high-resolution manometry before and after surgery. Surg Endosc Other Interv Tech. 2012;26:3642–9.CrossRefGoogle Scholar
  43. 43.
    Myers JC, Nguyen NQ, Jamieson GG, Van’t Hek JE, Ching K, Holloway RH, et al. Susceptibility to dysphagia after fundoplication revealed by novel automated impedance manometry analysis. Neurogastroenterol Motil. 2012;24:812–e393.CrossRefPubMedGoogle Scholar
  44. 44.
    Loots C, van Herwaarden MY, Benninga MA, VanderZee DC, van Wijk MP, Omari TI. Gastroesophageal reflux, esophageal function, gastric emptying, and the relationship to dysphagia before and after antireflux surgery in children. J Pediatr. 2013;162(3):566–73.e2. Mosby, Inc.CrossRefPubMedGoogle Scholar
  45. 45.
    Stoikes N, Drapekin J, Kushnir V, Shaker A, Brunt LM, Gyawali CP. The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery. Surg Endosc. 2012;26(12):3401–7.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Rosen R, Rodriguez L, Nurko S. Pediatric rumination subtypes: a study using high-resolution esophageal manometry with impedance. Neurogastroenterol Motil. 2016;29:e12998.CrossRefGoogle Scholar
  47. 47.
    Singendonk MMJ, Oors JM, Bredenoord AJ, Omari TI, van der Pol RJ, Smits MJ, et al. Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry. Neurogastroenterol Motil. 2017;29:e12996.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Human Physiology, Medical Science and TechnologySchool of Medicine, Flinders UniversityAdelaideSouth Australia

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