What Is the Impact of High-Resolution Manometry in the Functional Diagnostic Workup of Gastroesophageal Reflux Disease

Abstract

International guidelines agree that high-resolution esophageal manometry (HRM) is an integral part of the diagnostic evaluation of patients with refractory reflux symptoms and should be performed before antireflux surgery. Its most important goal is to explore differential diagnoses, in particular major esophageal motility disturbances, that may be responsible for symptoms. HRM additionally provides insights into all relevant pathomechanisms of gastroesophageal reflux disease (GERD): It can reveal important information on the morphology and function of the esophagogastric junction (EGJ), the presence of a hiatus hernia, transient lower esophageal sphincter relaxations, and dysmotility of the esophageal body. To obtain this information, a 3-step hierarchical system has been proposed for the algorithmic characterization of esophageal motor function. The first step is to investigate the morphology and contractility of the EGJ, the second to monitor esophageal body motor patterns in response to water swallows, and the third to determine the contraction reserve in patients with abnormal esophageal motor function using provocation tests. Observations made with HRM can not only explain the cause of symptoms in GERD patients but may also have the potential to direct specific treatment.

Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients’ Quality of Life—A Prospective Cohort Study

“…Thus far, no specific motility patterns of acid-dependent diseases have been identified, but HRM invariably remains an integral part of the diagnosis of dysphagia [ 21 ]. In the case of GERD with symptoms resistant to treatment, it is performed to qualify for anti-reflux surgery—so it can not only explain the cause of symptoms by assessing the function of the EGJ, the presence of a hiatal hernia or LES incontinence but it may condition making therapeutic decisions [ 13 ]. It is estimated that in approximately 5.7% of cases, underdiagnosed SR or EoE may be responsible for the presence of EGJ outflow obstruction.…”

“…In the etiology of dysphagia, which is a symptom of these diseases, esophageal motility disorders are also important, as it may be the cause and predictor or be a secondary effect and complication of acid-dependent esophageal diseases. However, the manometric findings in patients with EoE, ERD and SR are inconsistent and ambiguous [ 12 , 13 , 14 ]. Thus far, the significance of the possible coexistence of manometric disorders with the discussed esophageal diseases in the context of decreased quality of life of patients with these disorders has not been assessed.…”

Study on The Symptoms and Esophageal Motility Characteristics of Gastroesophageal Reflux Disease Patients with Obesity

“…HRM's revolutionary technology makes it possible for doctors to observe and measure changes in pressure throughout the esophagus (that is, from UES to LES). 31 In 2009, in order to cope with the rapid development of diagnosis and treatment of GERD, a classification method of esophageal motility disorder, The Chicago Classification, was developed for HRM. The updated version 3.0 is now widely used in clinic.…”

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

“…As not each patient can be provided with the complete 'toolbox' of functional investigations, proper selection is the key to successful therapy and long-term follow-up. The adequate assessments are discussed in the reviews by Keller [3] and Gockel et al [5]. Chronic constipation is a very common medical problem, and -depending on the definition -up to 15% of the general German population report symptoms of constipation.…”