Utility Of Esophageal Manometry Research Articles

Practice guidelines on the use of esophageal manometry – A GISMAD-SIGE-AIGO medical position statement

Patients with esophageal symptoms potentially associated to esophageal motor disorders such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal manometry in clinical practice is: (1) to accurately define esophageal motor function, (2) to identify abnormal motor function, and (3) to establish a treatment plan based on motor abnormalities. With this in mind, in the last decade, investigations and technical advances, with the introduction of high-resolution esophageal manometry, have enhanced our understanding and management of esophageal motility disorders. The following recommendations were developed to assist physicians in the appropriate use of esophageal manometry in modern patient care. They were discussed and approved after a comprehensive review of the medical literature pertaining to manometric techniques and their recent application. This position statement created under the auspices of the Gruppo Italiano di Studio per la Motilità dell’Apparato Digerente (GISMAD), Società Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE) and Associazione Italiana Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help clinicians in applying manometric studies in the most fruitful manner within the context of their patients with esophageal symptoms.

Su1887 The Role of Esophageal Manometry and 24 Hour pH With Impedance Studies in the Evaluation of Patients With Non-Cardiac Chest Pain

Background: Gastroesophageal reflux disease (GERD) is thought to be the most common cause of Non-Cardiac Chest Pain (NCCP), present in up to 60% of these patients. Esophageal manometry (EM) and 24 pH with impedance are commonly used in the evaluation of NCCP once an empiric proton pump inhibitor (PPI) trial has failed. However, the diagnostic utility of EM and 24 hour pH with impedance in NCCP patients has not been well studied. Aim: To evaluate the utility of esophageal EM and 24 hour pH with impedance in the evaluation of NCCP Methods: A retrospective chart review was performed on patients referred for the evaluation of NCCP. All patients underwent EM and 24-hour pH with impedance studies between 2006 and 2011. Esophageal manometry results were reviewed for underlying neuromuscular dysfunction and motility disorders. 24 hour pH with impedance data was reviewed for the presence or absence of acid or non-acid reflux. The validated JohnsonDeMeester (JD) score (normal , 22) was used to assess for the presence of GERD. Additionally, correlation between chest pain and reflux events was assessed. Prior endoscopic reports were reviewed for the presence of esophageal changes, such as, erosive esophagitis, salmon colored tongues, Schatzki's ring or changes suggestive of eosinophilic esophagitis. Categorical data was expressed as percentages and continuous data as means and standard deviation. Fisher's exact tests and parametric statistics were used to analyze data. A p-value ≤ 0.05 was considered statistically significant. Results: Esophageal manometry and 24-hour pH with impedance studies of 112 patients were reviewed (52.3% male, 60.4% Caucasian, mean age 51 ± 13.4, mean BMI 27.8 ± 5.1). Of the cohort, 65% of EM studies were normal (mean DCI 1574 ± 1107, mean lower esophageal sphinchter (LES) pressure 14.91 ± 9.75). Of the 34.5% abnormal manometry studies, ineffective esophageal motility disorder (n=25), hypotensive LES (n=5), nutcracker esophagus (n=4), and hypertensive LES (n=1) were present. Ninety percent (n= 88) had normal 24 hour pH studies (mean JD score 9.86 ¬¬± 17.9). Eighty-six percent (n= 88) had normal impedance studies and only 6.25% of patients (n=7) had at least one episode of chest pain correlating with acid or non-acid reflux. On endoscopy, 16% of patients (n=18) had esophageal changes suggestive of reflux and 8% (n=9) had a hiatal hernia. Conclusion: The majority of patients who underwent EM and 24 hour pH with impedance examination had normal studies. The role of these studies for the evaluation of NCCP is limited.

Utility of esophageal manometry and pH-metry in gastroesophageal reflux disease before surgery

The necessity of manometric evaluation before fundoplication in patients with gastroesophageal reflux disease is still a matter of debate. However, misdiagnosis can be responsible for postoperative problems. We aimed to evaluate the necessities of manometry and pH-metry before fundoplication in order to prevent possible complications after surgery. Between 1997 and 2004, 259 consecutive patients who referred to our laboratory with a diagnosis of gastroesophageal reflux disease and request for manometric test before surgery were evaluated retrospectively. Manometric analysis was performed in all patients and 24-hour ambulatory pH-metry in 91 of them. The mean age of the patients was 42.6+/-13 years and 51% were female. While 102 (39.4%) of the patients had normal esophageal motility, 122 (47.1%) had gastroesophageal reflux-related dysmotility (22% with ineffective esophageal motility, 25.1% with hypotensive lower esophageal sphincter). Primary esophageal motility disorders were detected in 29 (11.2%) patients (4 achalasia, 24 uncoordinated contractions and 1 nutcracker esophagus). Six patients had secondary dysmotility caused by scleroderma. Pathologic reflux was detected in 54 (59.3%) patients in whom pH-metry was performed. Our results support that manometry and pH-metry must be performed before surgery in gastroesophageal reflux disease.

The Clinical Utility of Esophageal Manometry

Esophageal manometry (EM) is performed to evaluate symptoms of chest pain and dysphagia, although its clinical utility is not known. The aim of this study was to evaluate the clinical utility of EM by determining whether EM provides new information, changes diagnoses, or alters patient management. Before performing EM, referring providers noted indications for the test, symptoms, previous tests performed, and medication use. After EM was completed, a follow-up questionnaire ascertained whether EM provided new information or changed the patient's diagnosis or management plan. Patients provided demographic information. During a 12-month period, 569 EMs were performed and 444 were available for inclusion; 286 fully completed questionnaires were returned (64%) and are the basis for this analysis. The mean age (+/-SD) at the time of manometry was 52 (+/-15) years; 58% were women; 98% were white. EM was requested to assist placement of a pH measuring device (34%), and to evaluate symptoms of dysphagia (29%), chest pain (12%), or acid reflux (11%). Overall, 64% of EM were abnormal; 81% in gastroesophageal reflux disease patients, 74% in dysphagia, and 59% in chest pain. New information was obtained in 87% of patients, whereas a change in diagnosis occurred in 30% of patients, and management changed in 44% of patients. EM is a clinically useful test because it frequently provides new information and often changes patient diagnosis and management. The clinical utility of EM is greatest in patients with dysphagia.

The Clinical Utility of Esophageal Manometry

The Clinical Utility of Esophageal Manometry

AGA technical review on the clinical use of esophageal manometry

AGA technical review on the clinical use of esophageal manometry

Clinical utility of esophageal manometry (EM) and 24-hour pH recording (pHR)

Clinical utility of esophageal manometry (EM) and 24-hour pH recording (pHR)