Oesophageal high-resolution manometry: moving from research into clinical practice

Fox, Mark; Bredenoord, Albert J.

doi:10.1136/gut.2007.127993

Cited by 327 publications

(341 citation statements)

References 88 publications

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“…Potential aetio logies include incompletely expressed or early achalasia, oesophageal wall stiffness from an infiltrative disease or cancer, vascular obstruction, sliding or para-oesophageal hiatal hernia, abdominal obesity or the effects of opiates 44 . Similar findings are found also in patients with dysphagia after restrictive, antireflux and bariatric procedures [45][46][47] . However, two series published in the past few years found that many patients with EGJOO were minimally symptomatic or asymptomatic, that in 20-40% of cases the 'disorder' resolved spontaneously, and that only 12-40% were treated (conservatively) as having achalasia 48,49 .…”

Section: Achalasia With Preserved Peristalsissupporting

confidence: 84%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Achalasia With Preserved Peristalsissupporting

confidence: 84%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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“…Some authors consider them to be diagnostic criteria for some forms of achalasia and for diffuse spasms (DES) (85,86). The CCH does not assign a precise meaning to them.…”

Section: Current Situationmentioning

confidence: 99%

Practical aspects of high resolution esophageal manometry

Juan¹,

Ríos²,

Bueno³

et al. 2016

Rev Esp Enferm Dig

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High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.

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“…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.…”

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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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Oesophageal high-resolution manometry: moving from research into clinical practice

Cited by 327 publications

References 88 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Practical aspects of high resolution esophageal manometry

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

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