Normative reference values for esophageal high‐resolution manometry in healthy adults: A systematic review

Abstract

Esophageal manometry has been widely used to diagnose esophageal motility disorders. 1 It is the standard diagnostic tool in nonobstructive dysphagia, as it evaluates both pressures of the lower esophageal sphincter (LES) and contractility of the esophageal body. An important advancement in the last 20 years has been the introduction of high-resolution manometry (HRM), usually defined as manometry carried out with a catheter with at least 21 channels and with sensors at 1-cm intervals. 2 HRM is swiftly replacing conventional manometry, in which only a limited number of sensors (usually 4 to 8) are used. The generally perceived advantages of HRM over conventional manometry are that positioning of the catheter is less critical and that the interpretation of the recorded pressures, displayed in the form of topographical color-coded plots, is more intuitive. 3

High‐resolution impedance manometry for comparing bolus transit between patients with non‐obstructive dysphagia and asymptomatic controls

“…To minimize the remnant bolus between each swallow, which could have affected the HRIM results, we performed the test in the sitting position. Gonzalez et al 13 reported that while the IEM diagnosis was affected by changes in position to supine or sitting, that of achalasia was not significantly affected. The diagnosis of other spastic motility disorders may also be affected by the position of manometry.…”

“…NOD was identified according to Rome IV criteria 6 : a sensation of abnormal bolus transit through the esophageal body with a thorough exclusion of structural lesions, gastroesophageal reflux disease (GERD), and histopathology‐based esophageal motor disorders which had not been diagnosed with a major Chicago classification v3.0 motility disorder such as achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, jackhammer esophagus, and absent peristalsis 1,11,12 . Propensity score matching (PSM) was performed for age, sex, and body mass index (BMI) to identify eligible participants among asymptomatic controls, patients with NOD, and patients with achalasia 13,14 …”

“…1,11,12 Propensity score matching (PSM) was performed for age, sex, and body mass index (BMI) to identify eligible participants among asymptomatic controls, patients with NOD, and patients with achalasia. 13,14 Asymptomatic controls did not have symptoms of dysphagia, chest pain, regurgitation, globus sensation, hoarseness, or epigastric pain, all of which were excluded using the Rome III questionnaire 15 and GerdQ questionnaire. 16 Upper endoscopy was performed for all included patients to exclude structural diseases based on previous upper endoscopy performed within 1 year of measurement.…”

“…In the achalasia group, 10 (83%) patients were diagnosed with type II achalasia and 2 (17%) were diagnosed with type III achalasia. As defined according to the Chicago classification v3.0, the achalasia group showed a significantly higher median IRP (33.0 mmHg [range, ) than did the control group (11 mmHg [range,(8)(9)(10)(11)(12)(13)(14)(15)(16); p < 0.01) and the NOD group (9.0 mmHg [range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; p < 0.01). Among the three groups, the achalasia group had the highest median LES pressure (achalasia vs. control vs. NOD: 44 vs. 25.2 vs. 18.5 mmHg, respectively; p < 0.01) and the lowest percentage of complete bolus transit (achalasia vs. control vs. NOD: 14% ± 15.1% vs. 49% ± 25.7% vs. 57% ± 31.4%, respectively; p < 0.01).…”

Variations in Clinical Practice of Esophageal High-resolution Manometry: A Nationwide Survey

“… 9 , 10 On the other hand, recent systematic reviews consistently showed that the distal contractile integral is significantly lower in the upright position than in the supine position. 10 , 11 Since at least some HRM metrics are position-dependent, it is necessary to establish and utilize posture-specific normative values in esophageal HRM. 6 , 12 - 15 Otherwise, a change of position could be included in the standard supine protocol as an adjunctive or complementary tool to enhance the diagnostic performance of esophageal HRM.…”