High‐resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry

Fox, Mark; Hebbard, Geoffrey; Janiak, Patrick; Brasseur, James G.; Ghosh, Sudip Kumar; Thumshirn, Miriam; Fried, Michael; Schwizer, Werner

doi:10.1111/j.1365-2982.2004.00539.x

Cited by 223 publications

(223 citation statements)

References 30 publications

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“…High resolution manometry allows a more detailed evaluation of the relaxation of the upper and lower esophageal sphincter and esophageal peristalsis. Recent studies indicate that it might be superior to conventional manometry in predicting bolus transit 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Pohl

Ribolsi

Savarino

et al. 2008

The American Journal of Gastroenterology

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BACKGROUND: Esophageal motility studies in humans have documented a low-pressure zone (LPZ) in the area of transition from striated to smooth muscle. While preliminary studies indicate that a bolus might be retained in this area, the clinical relevance of the LPZ remains unclear. AIM: To investigate a possible relationship between esophageal symptoms and the size of the esophageal LPZ. METHODS: We reviewed high-resolution manometry (HRM) data from patients with esophageal symptoms (dysphagia, chest pain, and heartburn/regurgitation) and asymptomatic volunteers. The proximal border of the LPZ was defined as the point where the amplitude of the proximal contraction wave declined below 30 mmHg, and the distal border as the point where the distal contraction wave first increased above 30 mmHg. RESULTS: The average (+/-standard error of mean [SEM]) length of the LPZ in 44 asymptomatic individuals was 5.4 +/-0.6 cm and did not differ (P= 0.222) from the LPZ in 64 patients with dysphagia (6.8 +/-0.4 cm), 34 patients with chest pain (6.4 +/-0.6 cm), and 42 patients with gastroesophageal reflux disease (GERD) symptoms (7.0 +/-0.6 cm). These results did not change when the length of the LPZ was corrected for total esophageal length. The time width of the LPZ in asymptomatic individuals (1.6 +/-0.2 s) was shorter than in patients with dysphagia and GERD symptoms (dysphagia 2.4 +/-0.2 s, GERD symptoms 2.8 +/-0.3 s). CONCLUSION: A time delay between the proximal and distal esophageal contraction waves might be a meaningful variable in GERD and dysphagia.Pohl et al. 1

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Section: Introductionmentioning

confidence: 99%

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Pohl

Ribolsi

Savarino

et al. 2008

The American Journal of Gastroenterology

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“…Such patients who are thought to have variants of achalasia respond well to LOS-disruptive procedures (Hirano et al, 2001). HRM in patients who have usually little if any oesophageal dilatation and varying abnormalities of oesophageal body function has shown that the orad excursion of the LOS during swallowing is preserved (Clouse et al, 2000;Hirano et al, 2001;Staiano et al, 2001;Fox et al, 2004), explaining why "conventional" assessment of swallow-induced LOS relaxation with a single stationed side hole or transducer fails to detect the impaired relaxation (Fig. 4).…”

Section: Understanding Abnormal Resistance To Flow Into the Stomach Fmentioning

confidence: 99%

“…The spatial resolution of HRM is sufficient to allow monitoring of the pressure profile across even small hiatus hernias (Fox et al, 2004) (Fig. 3).…”

Section: Dissection Of the Mysteries Of Hiatus Herniamentioning

confidence: 99%

“…3 and 5). HRM also tracks dynamic variations of gastro-oesophageal junction anatomy, including its descent due to diaphragmatic traction with respiration (Pandolfino et al, 2006a) and elevation, ascribable to oesophageal longitudinal muscle contraction (Clouse et al, 2000;Hirano et al, 2001;Staiano and Clouse, 2001;Fox et al, 2004). When combined with fluoroscopy or pH monitoring and/or impedance monitoring, HRM is a powerful approach for understanding the detailed mechanics of individual episodes of gastro-oesophageal reflux.…”

Section: Definition Of Mechanisms Of Gastro-oesophageal Refluxmentioning

confidence: 99%

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Approaches to driving the evolving understanding of lower oesophageal sphincter mechanical function

Dent

2007

J. Smooth Muscle Res.

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This article reviews and places into context the development of lower oesophageal sphincter (LOS) manometry, the key technique for researching the mechanics of this region. The first of two major challenges, being able to record sphincter pressure accurately with generally available equipment, was solved by the advent of perfused manometry in the 1960s. The other main challenge was to achieve reliable, continuous recording of LOS pressure, despite the constant movements of the LOS relative to the manometric catheter. Though well documented, this challenge is still poorly understood and prioritised, as many clinical/diagnostic and research manometric studies use methods for LOS manometry that are invalidated by LOS movement. There are two techniques that can record continuously from the LOS, despite its movements: high resolution manometry (HRM), which uses multiple point pressure sensors spaced at 1 cm interval or less, and the sleeve, which is a single long sensor. HRM provides valuable additional information on the varied topography of pressure patterns across the gastro-oesophageal junction and how this can change in an individual, second to second. HRM especially, but also sleeve manometry continue to advance understanding of the mechanics of gastro-oesophageal reflux, to unravel the mysteries of the mechanics of hiatus hernia and the diaphragmatic hiatus, to define why antireflux surgery fails or causes dysphagia, to recognise patients with dysphagia due to isolated defects of LOS relaxation and to test novel therapies for reflux disease directed at LOS function. Ample evidence now exists that accurate monitoring of LOS and gastro-oesophageal junction pressures is important for the diagnostic assessment of many patients and for advancing research into several aspects of the mechanical function of the LOS and its surrounding structures. This evidence now needs to be better reflected in the methods used for routine clinical practice and research.

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“…This might be due to widely spaced sensors in the catheter. Due to large number of sensors, HRM is expected to have higher fidelity to diagnose esophageal motility disorders, which has been documented in the literature [9]. One of the many advantages of the Clouse plot in HRM is the ease with which different esophageal motility disorders can be grossly recognized by the experienced motility doctors, but in the era of super-speciality health care using evidenced-based medicine and various mathematical scoring systems, are the doctors and patients happy with gross recognition of disorders?…”

mentioning

confidence: 99%

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

Ghoshal

2014

Indian J Gastroenterol

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High-resolution manometry (HRM), a landmark concept in gastrointestinal motility study, was introduced in the early 1990s by Clouse and Staiano [1]. 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. The advantages of HRM over conventional manometry with respect to the data recording include (a) higher number of sensors that record lumen-occlusive contractions of the circular muscle of esophagus (typically six to eight ports in the earlier conventional manometry in contrast to 32 ports in current HRM), (b) use of solid-state catheter with higher fidelity in place of water-perfusion catheters, (c) use of circumferential in place of non-circumferential sensors, (d) facility to evaluate bolus transport by impedance monitoring that is available in most of the standard HRM devises, and (e) HRM is easier to perform than the conventional manometry. Display of the complex data using Clouse plot is a major advantage of HRM over conventional manometry. In the conventional manometry, the horizontal (X) axis depicts the time and the vertical (Y) axis represents the amplitude of contraction. In the Clouse plot of HRM, the horizontal (X) axis depicts the time, but the vertical (Y) axis represents the length of the esophagus. How to depict the amplitude of contraction then? Ray E Clouse decided to use different colors to represent the amplitude of contraction, the deep blue being the most negative pressure, and black showing highest positive pressure. Conventional manometry may miss esophageal motility disorders causing dysphagia. In a study on 250 patients with motor dysphagia, the cause could not be identified by conventional manometry in 15 % patients [8]. This might be due to widely spaced sensors in the catheter. Due to large number of sensors, HRM is expected to have higher fidelity to diagnose esophageal motility disorders, which has been documented in the literature [9]. One of the many advantages of the Clouse plot in HRM is the ease with which different esophageal motility disorders can be grossly recognized by the experienced motility doctors, but in the era of super-speciality health care using evidenced-based medicine and various mathematical scoring systems, are the doctors and patients happy with gross recognition of disorders?Chicago classification system has been developed by consensus among a group of motility experts based on the available evidence and general principles of esophageal physi...

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High‐resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry

Abstract: The HRM predicts bolus movement more accurately than conventional manometry and identifies clinically relevant oesophageal dysfunction not detected by other investigations including conventional manometry.

Cited by 223 publications

References 30 publications

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Approaches to driving the evolving understanding of lower oesophageal sphincter mechanical function

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

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