A Pictorial Presentation of Esophageal High Resolution Manometry Current Parameters

Abstract

Introduction:High resolution manometry is the current technology used to the study of esophageal motility and is replacing conventional manometry in important centers for esophageal motility with parameters used on esophageal motility, following the Chicago Classification. This classification unifies high resolution manometry interpretation and classifies esophageal disorders. Objective:This review shows, in a pictorial presentation, the new parameters established by the Chicago Classification, version 3.0, aimed to allow an easy comprehension and interpretation of high resolution manometry. Methods:Esophageal manometries performed by the authors were reviewed to select illustrative tracings representing Chicago Classification parameters. Results:The parameters are: Esophagogastric Morphology, that classifies this junction according to its physiology and anatomy; Integrated Relaxation Pressure, that measures the lower esophageal sphincter relaxation; Distal Contractile Integral, that evaluates the contraction vigor of each wave; and, Distal Latency, that measures the peristalsis velocity from the beginning of the swallow to the epiphrenic ampulla. Conclusion:Clinical applications of these new concepts is still under evaluation.

Evaluation of Esophageal Achalasia: From Symptoms to the Chicago Classification

“…The introduction of high resolution manometry has improved the ability to diagnose achalasia and identify newer variants. More detailed parameters were created based on technological improvements 12 . LES relaxation is measured more precisely by the Integrated Relaxation Pressure that corresponds to the mean pressure of 4 s of greatest post-deglutitive relaxation in a 10 s gap, triggered at the beginning of a swallow 13 .…”

Normative Values for a New Water-Perfused High Resolution Manometry System

“…A reliable assessment of the relaxation of the LES is probably the best contribution of HRM (7,16) . The concentration of sensors provided by the technology compensates for motion artifacts avoiding erroneous interpretation of LES pseudo-relaxation (17) and allows a more sophisticated parameter to evaluate relaxation in opposition to nadir pressure only, the IRP (16) . Water-perfused Silva RMB, Herbella FAM, Gualberto D. Valores de normalidade de um novo sistema de manometria de alta resolução por perfusão de água.…”

Perspective Chapter: Update on Achalasia Treatment

“…In order to understand the motility and function of the esophagus, the high-resolution manometry in conjunction with the new Chicago Classification 4.0 has allowed for better understanding, earlier diagnosis and improved classification of esophageal motility disorders [1,17]. The HRM is able to provide images detailing the information regarding vigor of each swallow, peristalsis, relaxation and pressure of the upper and lower esophageal sphincters, thereby improving diagnostic accuracy [18].…”