High‐resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities

Abstract

High-resolution manometry capable of pressure monitoring from the pharynx to the stomach together with pressure topography plotting represents an unquestionable evolution in oesophageal manometry. However, with this advanced technology come challenges and one of those is devising the optimal scheme to apply high-resolution oesophageal pressure topography (HROPT) to the clinical evaluation of patients. The first iteration of the Chicago classification was based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. This review summarizes the analysis process as it has evolved. Individual swallows are analysed in a stepwise fashion for the morphology of the oesophagogastric junction (OGJ), the extent of OGJ relaxation, the propagation velocity of peristalsis, the vigour of the peristaltic contraction, and abnormalities of intrabolus pressure utilizing metrics that have now been customized to HROPT. These results are then synthesized into a comprehensive diagnosis that, although based on conventional manometry criteria, is also customized to HROPT measures. The resultant classification objectifies the identification of three unique subtypes of achalasia. Additionally, it provides enhanced detail in the description of distal oesophageal spasm, nutcracker oesophagus subtypes, and OGJ obstruction. It is our expectation that modification of this classification scheme will continue to occur and this should further clarify the utility of pressure topography plotting in assessing oesophageal motility disorders.

Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry

“…The distal contractile integral (DCI) was an integrated calculation, which includes the length, contractile vigor, and duration of contraction in the smooth muscle segment of the esophagus at the 20 mmHg isobaric contour. [17][18][19] Integrated relaxation pressures (IRP) were measured as the mean EGJ pressure measured with an electronic equivalent of a sleeve sensor for 4 contiguous or non-contiguous seconds of relaxation in the 10 second window following deglutitive UES relaxation. [17][18][19] CFV, DL, DCI, and IRP were expressed as the average of 10 liquid swallows.…”

“…[17][18][19] Integrated relaxation pressures (IRP) were measured as the mean EGJ pressure measured with an electronic equivalent of a sleeve sensor for 4 contiguous or non-contiguous seconds of relaxation in the 10 second window following deglutitive UES relaxation. [17][18][19] CFV, DL, DCI, and IRP were expressed as the average of 10 liquid swallows. Measurement of LES relaxation pressure, resting pressure, and length, as well as UES pressures, were automatically performed using analysis software, after manual inspection and correction of placement of dedicated markers.…”

How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease

“…[1][2][3][4][5][6] It nevertheless involves some challenges such as determining the optimal protocol for HRM in clinical practice. [7][8][9] The test is usually performed in the supine position. 6,10 The published normative reference values are for this position too and the Chicago classification 7 is applied to them.…”

Chicago classification of high-resolution esophageal manometry: Is old the gold or is new better?

“…In this new technology, pressure profile is assessed during several liquid and viscous swallows using a catheter having a large number of ports at closely spaced positions in the esophagus [2]. Time, catheter position, and average pressure are then reconstructed into pseudo-3D "topographic plots" that demonstrated the functional anatomy of the esophagus and that of the gastroesophageal junction taking gastric pressure as the baseline [2].There are several advantages of HRM over conventional manometry [2][3][4][5][6][7]. The advantages may be broadly classified into two groups, (a) those related to the recording of the data and (b) those related to the display of the data.…”

“…There are several advantages of HRM over conventional manometry [2][3][4][5][6][7]. The advantages may be broadly classified into two groups, (a) those related to the recording of the data and (b) those related to the display of the data.…”