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High-resolution esophageal manometry: interpretation in clinical practice

Yadlapati, Rena

Current Opinion in Gastroenterology: July 2017 - Volume 33 - Issue 4 - p 301–309
doi: 10.1097/MOG.0000000000000369
ESOPHAGUS: Edited by Stuart J. Spechler
Editor's Choice

Purpose of review Esophageal high-resolution manometry (HRM) is the current state-of-the-art diagnostic tool to evaluate esophageal motility patterns and, as such, is widely adopted in clinical practice. This article will review the interpretation of esophageal HRM in clinical practice.

Recent findings HRM uses a high-resolution catheter to transmit intraluminal pressure data that are subsequently converted into dynamic esophageal pressure topography (EPT) plots. Metric data from EPT plots are synthesized to yield an esophageal motility diagnosis according to the Chicago Classification, a formal analytic scheme for esophageal motility disorders, which is currently in version 3.0. The standard HRM protocol consists of a baseline phase and a series of 10 wet swallows in the supine or reclined position. In addition, data from swallows in the seated position and provocative HRM maneuvers provide useful information about motility properties. Combined high-resolution impedance technology is also clinically available and enables concurrent assessment of bolus transit and postprandial responses. Finally, there is ongoing interest to optimize the training and competency assessment for interpretation of HRM in clinical practice.

Summary Esophageal HRM is a valuable and sophisticated clinical tool to evaluate esophageal motility patterns. Emerging clinical applications of esophageal HRM include combined impedance technology, provocative maneuvers, and postprandial evaluation.

Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Correspondence to Rena Yadlapati, MD, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair St. Suite 1400 Chicago, IL 60611, USA. Tel: +1 312 926 7648; fax: +1 312 695 3999; e-mail:

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