Abstract
Esophageal manometry has been considered the “gold standard” test for the evaluation of esophageal motor function. At present, abnormal motor activity as measured by “conventional manometry” is defined in terms of a few basic patterns: incomplete sphincter relaxation, esophageal spasm, hypertensive contractions, and loss of tone and motility. Only achalasia and severe diffuse esophageal spasm are specific disorders with manometric abnormalities that are absent in healthy subjects. Other esophageal motility disorders are poorly defined, often include “abnormalities” that can be found in symptom-free individuals as well and are inconsistent over time. High-resolution manometry (HRM) was developed to increase interpretative consistency and diagnostic accuracy of esophageal manometry. One of the most important advantages of HRM is that it makes diagnostic esophageal manometry easier and quicker to perform. HRM identifies patients with poor coordination between the proximal and mid-esophagus (wide “transition zone”), focal hypotensive contractions, or focal spasm that would be missed by conventional manometry. Crucially, HRM can distinguish between abnormalities that disturb bolus transport from abnormalities that have no effect on function. HRM has been shown to increase diagnostic accuracy. Recently, Goldani et al. have illustrated the use of HRM in a pediatric age group while using a standardized protocol and analytical method. Despite the inherent limitations of the pediatric population, the authors introduced a new protocol in unsedated children in the context of a clinical setting, moving from research into clinical application. HRM may prove to have clinical advantages in pediatric patients as it has in adults, but further proof of its usefulness in these subjects will be required.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Clark JH. Anatomy and physiology of the esophagus. In: Wyllie R, Hyams JS, editors. Pediatric gastrointestinal disease, pathophysiology, diagnosis and management. Philadelphia, PA: WB Saunders; 1993. p. 311–7.
Grand RJ, Watkins JB, Torti FM. Development of the human gastrointestinal tract, a review. Gastroenterology. 1976;70:790–810.
Grybowski JD. The swallowing mechanism of the neonate: I. Esophageal and gastric motility. Pediatrics. 1965;35:445–52.
Grybowski JD, Thayer WR, Spiro HM. Esophageal motility in infants and children. Pediatrics. 1963;31:382–95.
Cucchiara S, Borrelli O, Di Nardo G. Esophageal motility. In: Walker WA et al., editors. Walker’s pediatric gastrointestinal disease, 5th ed. BC Decker Inc: Hamilton; 2008. p. 47–58.
Kahrilas PJ, Dodds WJ, Dent J, et al. Upper esophageal function during belching. Gastroenterology. 1986;91:133–40.
Moroz SP, Espinoza J, Cumming WA, Diamant NE. Lower esophageal sphincter function in children with and without gastresophageal reflux. Gastroenterology. 1976;71:236–41.
Kahrilas PJ, Clouse RE, Hogan WJ. An American Gastroenterological Association Medical Position statement on the clinical use of esophageal manometry. Gastroenterology. 1994;107:1865–84.
Newell SJ, Sarkar PK, Durbin GM, Booth IW, McNeish AS. Maturation of the lower esophageal sphincter in the preterm baby. Gut. 1988;29:167–72.
Savarino E, Tutuian R. Combined multichannel intraluminal impedance and manometry testing. Dig Liver Dis. 2008;40:167–73.
Gilger MA, Boyle JT, Sondheimer JM, Colletti RB. A Medical Position Statement of the North American Society for Pediatric Gastroenterology and Nutrition: indications for pediatric esophageal manometry. J Pediatr Gastroenterol Nutr. 1997;24:616–8.
Fung KP, Math MV, Ho CO, Yap KM. Midazolam as a sedative in esophageal manometry: a study of the effect on esophageal motility. J Pediatr Gastroenterol Nutr. 1992;15:85–8.
Vanderhoof JA, Rappaport PJ, Paxson CL. Manometric diagnosis of lower esophageal sphincter incompetence in infants: use of a small, single-lumen perfused catheter. Pediatrics. 1978;62:805–8.
Orenstein SR, Giarrusso VS, Proujansky R, Kocoshis SA. The Santmyer swallow: a new useful infant reflex. Lancet. 1988;1:345–6.
Fox MR, Bredenoord AJ. Esophageal high-resolution manometry: moving from research into clinical practice. Gut. 2008;57:405–23.
Spechler SJ, Castell DO. Classification of esophageal motility abnormalities. Gut. 2001;49:145–51.
Pandolfino JE, Kahrilas PJ. AGA technical review on the clinical use of esophageal manometry. Gastroenterology. 2005;128:209–24.
Nayar DS, Khandwala F, Achkar E, et al. Esophageal manometry: assessment of interpreter consistency. Clin Gastroenterol Hepatol. 2005;3:218–24.
Reidel WL, Clouse RE. Variations in clinical presentation of patients with esophageal contraction abnormalities. Dig Dis Sci. 1985;30:1065–71.
Achem SR, Crittenden J, Kolts B, et al. Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders. Am J Gastroenterol. 1992;87:825–30.
Swift GL, Alban-Davies H, McKirdy H, et al. A long-term clinical review of patients with esophageal pain. Q J Med. 1991;81:937–44.
Clouse RE, Staiano A, Alrakawi A. Development of a topographic analysis system for manometric studies in the gastrointestinal tract. Gastrointest Endosc. 1998;48:395–401.
Clouse RE, Prakash C. Topographic esophageal manometry: an emerging clinical and investigative approach. Dig Dis Sci. 2000;18:64–74.
Fox M. High resolution manometry—an introduction. Guy’s and St Thomas’ NHS Foundation Trust: London; 2006, p. 1–10.
Fox M, Hebbard G, Janiak P, Brasseur JG, Ghosh S, Thumshirn M, Fried M, Schwizer W. High-resolution manometry predicts the success of esophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil. 2004;16:533–42.
Ghosh SK, Janiak P, Schwizer W, Hebbard GS, Brasseur JG. Physiology of the esophageal pressure transition zone: separate contraction waves above and below. Am J Physiol Gastrointest Liver Physiol. 2006;290:G568–76.
Tutuian R, Castell DO. Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients. Am J Gastroenterol. 2004;99:1011–9.
Ghosh SK, Pandolfino JE, Zhang Q, Jarosz A, Shah N, Kahrilas PJ. Quantifying Esophageal Peristalsis with High-Resolution Manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290:G988–97.
Staiano A, Clouse RE. Detection of incomplete lower esophageal sphincter relaxation with conventional point-pressure sensors. Am J Gastroenterol. 2001;96:3258–67.
Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–30.
Williams RB, Pal A, Brasseur JG, Cook IJ. Space-time pressure structure of pharyngo-esophageal segment during swallowing. Am J Physiol Gastrointest Liver Physiol. 2001;281:G1290–300.
Staiano A, Boccia G, Miele E, Clouse RE. Segmental characteristics of esophageal peristalsis in paediatric patients. Neurogastroenterol Motil. 2008;20:19–26.
Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;261:G677–84.
Clouse RE, Staiano A. Topography of esophageal motility in patients with normal and high-amplitude esophageal peristalsis. Am J Physiol. 1993;265:G1098–107.
Clouse RE, Alrakawi A, Staiano A. Intersubject and interswallow variability in the topography of esophageal motility. Dig Dis Sci. 1998;43:1978–85.
Staiano A, Boccia G, Salvia G, Zappulli D, Clouse RE. Development of esophageal peristalsis in preterm and term neonates. Gastroenterology. 2007;132:1718–25.
Fox M, Menne D, Stutz B, Fried M, Schwizer W. The effects of tegaserod on esophageal function and bolus transport in healthy volunteers: studies using concurrent high-resolution manometry and videofluoroscopy. Aliment Pharmacol Ther. 2006;24:1017–27.
Goldani HA, Staiano A, Borrelli O, Thapar N, Lindley KJ. Pediatric esophageal high-resolution manometry: utility of a standard protocol and size-adjusted pressure topography parameters. Am J Gastroenterol. 2010;105:460–7.
Breumelhof R, Timmer R, van Hees PA, Obertop H, Smout AJ. Low-amplitude distal esophageal spasm as a cause of severe dysphagia for solid food. Am J Gastroenterol. 1996;91:143–6.
Pouderoux P, Shi G, Tatum RP, Kahrilas PJ. Esophageal solid bolus transit: studies using concurrent videofluoroscopy and manometry. Am J Gastroenterol. 1999;94:1457–63.
Jolley SG, Johnson DG, Roberts CC, Herbst JJ, Matlak ME, McCombs A, Christian P. Patterns of gastresophageal reflux in children following repair of esophageal atresia and distal tracheo-esophageal fistula. J Pediatr Surg. 1980;15:857–62.
Cheng W, Poon KH, Lui VCH, Yong JL, Law S, So KT, et al. Esophageal atresia and achalasia-like esophageal dysmotility. J Pediatr Surg. 2004;39:1581–3.
Dutta HK, Grover VP, Dwivedi SN, Bhatnagar V. Manometric evaluation of postoperative patients of esophageal atresia and tracheo-esophageal fistula. Eur J Pediatr Surg. 2001;11:371–6.
Ceriati E, De Peppo F, Ciprandi G, Marchetti P, Silveri M, Rivosecchi M. Surgery in disabled children: general gastroenterological aspects. Acta Paediatr Suppl. 2006;95:34–7.
Dent J, Holloway RH, Toouli J, Dodds WJ. Mechanisms of lower esophageal sphincter incompetence in patients with symptomatic gastresophageal reflux. Gut. 1988;29:1020–8.
Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, et al. Mechanism of gastresophageal reflux in recumbent asymptomatic human subjects. J Clin Invest. 1980;65:256–67.
Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109:601–10.
Werlin SL, Dodds WJ, Hogan WJ, Arndorfer RC. Mechanisms of gastresophageal reflux in children. J Pediatr. 1980;97:244–9.
Cucchiara S, Bortolotti M, Minella R, Auricchio S. Fasting and postprandial mechanisms of gastresophageal reflux in children with gastresophageal reflux disease. Dig Dis Sci. 1993;38:86–92.
Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastresophageal reflux in children. Gastroenterology. 1997;113:399–408.
Pensabene L, Miele E, Del Giudice E, Strisciuglio C, Staiano A. Mechanisms of gastresophageal reflux in children with sequelae of birth asphyxia. Brain Dev. 2008;30:563–71.
Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. 2008;103:27–37.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Buonavolontà, R., Russo, M., Turco, R., Staiano, A. (2013). Esophageal Manometry. In: Faure, C., Di Lorenzo, C., Thapar, N. (eds) Pediatric Neurogastroenterology. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-709-9_8
Download citation
DOI: https://doi.org/10.1007/978-1-60761-709-9_8
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60761-708-2
Online ISBN: 978-1-60761-709-9
eBook Packages: MedicineMedicine (R0)