Oesophageal manometry: 10-year audit from a specialist centre, and early experience with high-resolution manometry.

Abstract

Manometry is the gold standard investigation of innate or acquired motility disorders in the oesophagus. New technology in the form of high-resolution manometry (HRM) may supplant traditional water-perfused manometry and enhance standardisation of manometric interpretation and reporting. This study reports on a 10-year experience of 5,184 consecutive patients using the traditional methods, and an early experience with HRM. Of 5,184 patients assessed, 4,509 (87%) had both pH and manometry and 675 (13%) had manometry only. 3,523 (78%) of the pH /manometry group had normal motility, 635 (14%) showed ineffective motility (IM), 213 (5%) a non-specific motility disturbance (NSMD), 42 (0.9%) achalasia, 58 (1.3%) nutcracker oesophagus, 22 (0.5%) hypertensive LOS (HLOS), 8 (0.2%) diffuse oesophageal spasm (DOS) and 8 (0.2 %) had scleroderma. For those referred solely for manometry only, 324 (48%) had normal motility, 72 (11%) IM, 51 (8%) NSMD, 175 (26%) achalasia, 16 (2%) nutcracker oesophagus, 32 (5%) HLOS, 1 (0.1%) DOS and 4 (0.6%) had scleroderma. 92 patients to date have been studied with HRM, with enhanced definition of lower oesophageal sphincter (LOS) function. For patients referred for reflux related symptoms, motility disorders are present in 22% of the cases. Conversely, of the patients referred for dysphagia, motility disturbances are detected in 52% of the cases sent for manometry. Our initial experience shows that HRM technology is adding a valuable dimension and clearer understanding of motility patterns in the dysphagic patient.