Evaluation of esophageal motor function in clinical practice

Abstract

Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics.

Effects of Acotiamide on the Esophageal Motility Function in Patients with Esophageal Motility Disorders: A Pilot Study

“…As for treatment of EGJOO, the effects of noninvasive medications, such as L type Ca 2+ channel blockers and NO derivatives, are limited in patients with EGJOO. Those patients with severe symptoms may undergo invasive treatments usually performed on patients with achalasia, including endoscopic dilation, intrasphincteric botulinum toxin injection, or myotomy [20,22] , inasmuch as EGJOO may be a variant of achalasia. Although both achalasia and EGJOO are characterized by impaired LESR, the effects of acotiamide differed in patients with these 2 disorders.…”

Practical aspects of high resolution esophageal manometry

“…), and technical ones (diameter of the catheter, position of the patient, consistency of the bolus, etc.) (32)(33)(34)(35)(36). In addition, the analysis programs are not compatible and the elements of analysis cannot be superimposed.…”

“…Moreover, HRM has modified concepts, parameters and assessment methods with clear differences between different analysis programs (32,34).…”

A Case of Post-fundoplication Dysphagia: Another Possible Interpretation of the Manometric Findings

“…The irregular pressure pattern at the bottom of the image suggests the distal end of the catheter has not entered the stomach. This previously described "butterfly" pattern, 2 with a mirror image of pressure at the level of catheter curling, needs to be identified during acquisition to enable adjustments to be made to avoid a technically inadequate study. Also, the observation that "a sudden increase was noted in the LES pressure up to 300 mmHg after each wet swallow" is an artifact generated by an occluded sidehole of the bent catheter and is not attributable to the LES.…”

“…To correctlyevaluate the luminal EGJ pressures in this post fundoplication patient, a repeat manometryis advised, with gentle maneuvres to guide the catheter tip across the EGJ; 3 if this fails, then catheter placement under endoscopic guidance is recommended. 2 Additionally, a radiological contrast swallow will be helpful in identifying anyfunctional or anatomical anomaly, such as impaired esophageal outflow or a slipped fundoplication. 4 Both objective assessments can better inform clinical management decisions.…”