Role of oesophageal manometry in clinical practice *

Abstract

The present study evaluates the role of oesophageal manometry in clinical practice. Over 5 years, 347 consecutive patients were evaluated in our oesophageal laboratory. The reasons for referral were: dysphagia (11.5%), gastro-oesophageal reflux disease (GORD) (46.7%), non-cardiac chest pain (28.5%), connective tissue disease (6.9%) and other symptomatology (6.3%). Patients were classified into the following five groups according to the referral diagnosis: dysphagia (40 patients), gastro-oesophageal reflux disease (GORD) (162 patients), non-cardiac chest pain (99 patients), connective tissue disease (24 patients) and other symptomatology (22 patients). Abnormalities in oesophageal motility were detected in 90% of patients with dysphagia, in 40.1% of patients with GORD, in 47.5% of subjects with non-cardiac chest pain, in 45.8% of patients with connective tissue disease and in 18.2% of subjects with other symptomatology. The high prevalence of abnormalities in the dysphagia group was statistically significant (p < 0.001), and the range of 95% confidence intervals (0.81-0.99) suggests that the value found may be a reasonably good estimate of percentage of anomalies detectable in the dysphagia patient population. In the dysphagia group, the initial diagnosis was confirmed in 40% of patients and changed in 52.5%; in only 7.5% of cases were the manometry results not relevant for determining an appropriate diagnosis. Manometry substantially contributed to patients receiving the correct treatment in 82.5% of cases (p < 0.001 among all groups). In the GORD group and in the non-cardiac chest pain group, the results of manometry were not relevant for confirming or changing a diagnosis in 59.8% and 53.5% of cases respectively; nevertheless, in both groups, on the basis of manometry results, the treatment was changed in 42.5% of patients (p < 0.01 vs. other symptomatology group). In conclusion, on the basis of the present data, we can emphasize the usefulness of oesophageal manometry assessment in patients with dysphagia or non-cardiac chest pain, with negative routine examinations, and also in patients with refractory GORD who have been considered for antireflux surgery.

Does Chicago Classification address Symptom Correlation with High-resolution Esophageal Manometry?

“…Manometry is not a first-choice functional diagnostic test in the study of patients with GER or NCCP. 10 Gambitta et al, 11 however, highlighted the role of manometry in symptoms of dysphagia, chest pain, and refractory reflux disease. Ineffective esophageal motil-ity is an important cause of symptoms in patients with chest pain, dysphagia, and reflux symptoms.…”

Age and gender affect likely manometric diagnosis: Audit of a tertiary referral hospital clinical esophageal manometry service

“…Clinical esophageal motility studies have been widely available for more than two decades, and are frequently ordered in routine gastroenterological practice. There is, however, still significant discussion as to the utility and specific role of the test 1–5 . A better understanding of the yield of various diagnoses in different patient groups would enable more informed use of clinical motility services.…”

“…With any investigation, the pre‐test probability of an abnormality is important in guiding the ordering and interpretation of the test result. To date, there is limited information as to the rate and type of abnormalities found in unselected subjects referred for clinical esophageal motility function testing 1,4,5 . Most manometric series reported to date concentrate on specific diagnoses 6–9 or techniques 10 rather than examining the range and rate of diagnoses present in all referred patients.…”

“…There is, however, still significant discussion as to the utility and specific role of the test. [1][2][3][4][5] A better understanding of the yield of various diagnoses in different patient groups would enable more informed use of clinical motility services.…”

“…To date, there is limited information as to the rate and type of abnormalities found in unselected subjects referred for clinical esophageal motility function testing. 1,4,5 Most manometric series reported to date concentrate on specific diagnoses [6][7][8][9] or techniques 10 rather than examining the range and rate of diagnoses present in all referred patients. The effect of age and gender on diagnosis is also unclear.…”