Abstract
Motor function can be assessed by a variety of recording techniques including radiology, scintigraphy manometry, and most recently intraluminal electrical impedance monitoring. The gold standard, however, for the assessment of motor disorders remains manometry. Since its introduction in the early 1950s, esophageal manometry has contributed to a better understanding of esophageal motor function and has currently become a widely performed technique in clinical practice. In the last 10 years, a new system to perform esophageal manometry was developed and introduced in both research and clinical setting: the high-resolution manometry. It utilizes closely spaced pressure sensors to create a dynamic representation of pressure change along the entire length of the esophagus. Along with the technological innovation, an international consensus process has evolved over recent years to define esophageal motility disorders using HRM, Clouse plots, and standardized metrics. This classification, titled the Chicago Classification (CC), was firstly published in 2009 and updated in 2012 and in 2015 (v3.0). The key metrics of interpretation applied for the CC v3.0 are the integrated relaxation pressure (IRP), the distal contractile integral (DCI), and the distal latency (DL). In its last iteration, the CC utilizes a hierarchical approach, sequentially prioritizing (i) disorders of esophagogastric junction (EGJ) outflow (achalasia subtypes I–III and EGJ outflow obstruction), (ii) major disorders of peristalsis (absent contractility, distal esophageal spasm, hypercontractile esophagus), and (iii) minor disorders of peristalsis characterized by impaired bolus transit (“fragmented” contractions in case of large breaks in the 20-mmHg isobaric contour, ineffective esophageal motility). EGJ morphology, characterized by the degree of overlap between the lower esophageal sphincter and the crural diaphragm, and baseline EGJ contractility are also part of CC v3.0. Future developments of CC will include pharyngeal and UES functions, combined impedance measurements to assess the bolus flow, and swallow challenges to trigger motility abnormalities. In summary, the CC is an evolving process and much remains to be elucidated in the next versions.
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References
Crane RK, editor. Gastrointestinal physiology II. Baltimore: University Park Press; 1977.
Miller AJ. The neuroscientific principles of swallowing and dysphagia. San Diego: Singular Pub. Group; 1999.
Code CF. An Atlas of esophageal motility in health and disease. Springfield: Thomas; 1958.
Fransen G, Valembois P. Basic data anatomy and embryology. In: Vantrappen G, Hellemans J, editors. Diseases of the Esophagus. New York: Springer; 1978. p. 1–15.
Murray JA, Clouse RE, Conklin JL. Component of the standard oesophageal manometry. Neurogastroenterol Motil. 2003;15:591–606.
Butin JW, Olsen AM, Moersch HJ, Code CF. A study of esophageal pressures in normal persons and patients with cardiospasm. Gastroenterology. 1953;23:278–93.
Dent J. A new technique for continuous sphincter pressure measurement. Gastroenterology. 1976;71:263–7.
Soudagar AS, Sayuk GS, Gyawali CP. Learners favor high resolution oesophageal manometry with better diagnostic accuracy over conventional line tracings. Gut. 2012;61(6):798–803.
Pandolfino JE, Fox MR, Bredenoord AJ, et al. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil. 2009;21(8):796–806.
Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal esophageal pressure topography (EPT). Neurogastroenterol Motil. 2012;24 Suppl 1:57–65.
Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AMJP, Pandolfino JE, International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74.
Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;261(4 Pt 1):G677–84.
Clouse RE, Staiano A, Alrakawi A, Harolan A. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–30.
Pandolfino JE, Ghosh SK, Zhang Q, Jarosz A, Shah N, Kahrilas PJ. Quantifying EGJ morphology and relaxation with high-resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol. 2006;290:G1033–40.
Bredenoord AJ, Weusten BL, Timmer R, Smout AJ. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology. 2006;130:334–40.
Pandolfino JE, Kim H, Ghosh SK, et al. High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102(5):1056–63.
Tolone S, de Cassan C, de Bortoli N, Roman S, Galeazzi F, Salvador R, Marabotto E, Furnari M, Zentilin P, Marchi S, Bardini R, Sturniolo GC, Savarino V, Savarino E. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27(8):1175–82.
Tolone S, de Bortoli N, Marabotto E, de Cassan C, Bodini G, Roman S, Furnari M, Savarino V, Cocimo L, Savarino E. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;27(10):1423–31.
Lin Z, Kahrilas PJ, Roman S, et al. Refining the criterion for an abnormal integrated relaxation pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model. Neurogastroenterol Motil. 2012;24(8):e356–63.
Salvador R, Savarino E, Pesenti E, Spadotto L, Capovilla G, Cavallin F, Galeazzi F, Nicoletti L, Merigliano S, Costantini M. The impact of Heller myotomy on integrated relaxation pressure in esophageal achalasia. J Gastrointest Surg. 2016;20(1):125–31.
Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg. 2009;13:2219–25.
Gyawali CP, Kushnir VM. High-resolution manometric characteristics help differentiate types of distal esophageal obstruction in patients with peristalsis. Neurogastroenterol Motil. 2011;23:502–e197.
Kahrilas PJ, Peters JH. Evaluation of esophagogastric junction using high resolution manometry and esophageal pressure topography. Neurogastroenterol Motil. 2012;24(1):11–9.
van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015;27(9):1310–6.
Xiao Y, Kahrilas PJ, Kwasny MJ, Roman S, Lin Z, Nicodeme F, Lu C, Pandolfino JE. High-resolution manometry correlates of ineffective esophageal motility. Am J Gastroenterol. 2012;107:1647–54.
Kumar N, Porter RF, Chanin JM, Gyawali CP. Analysis of intersegmental trough and proximal latency of smooth muscle contraction using high-resolution esophageal manometry. J Clin Gastroenterol. 2012;46:375–81.
Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with dysphagia. Am J Gastroenterol. 2011;106:349–56.
Porter R, Kumar N, Drapekin J, Gyawali CP. Fragmented smooth muscle contraction segments on high resolution manometry: a marker of esophageal hypomotility. Neurogastroenterol Motil. 2012;24:763–8.
Pandolfino JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology. 2011;141(2):469–75.
Roman S, Pandolfino JE, Chen J, Boris L, Luger D, Kahrilas PJ. Phenotypes and clinical context of hypercontractility in high resolution pressure topography (EPT). Am J Gastroenterol. 2012;107:37–45.
Martinucci I, de Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, Savarino V, Savarino E. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5(2):86–96.
Pandolfino JE, Roman S. High-resolution manometry: an atlas of esophageal motility disorders and findings of GERD using esophageal pressure topography. Thorac Surg Clin. 2011;21:465–75.
Savarino E, Tutuian R. Combined multichannel intraluminal impedance and manometry testing. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Stud Liver. 2008;40:167–73.
Savarino E, Giacchino M, Savarino V. Dysmotility and reflux disease. Curr Opin Otolaryngol Head Neck Surg. 2013;21:548–56.
Savarino E, Gemignani L, Pohl D, Zentilin P, Dulbecco P, Assandri L, Marabotto E, et al. Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;34:476–86.
Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2001;5:260–5.
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986;91:897–904.
Lee J, Anggiansah A, Anggiansah R, Young A, Wong T, Fox M. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2007;5:1392–8.
Simren M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut. 2003;52:784–90.
Gyawali CP, Bredenoord AJ, Conklin JL, Fox M, Pandolfino JE, Peters JH, Roman S, et al. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil. 2013;25:99–133.
Basseri B, Pimentel M, Shaye OA, Low K, Soffer EE, Conklin JL. Apple sauce improves detection of esophageal motor dysfunction during high-resolution manometry evaluation of dysphagia. Dig Dis Sci. 2011;56:1723–8.
Fornari F, Bravi I, Penagini R, Tack J, Sifrim D. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2009;21:718–e741.
Stoikes N, Drapekin J, Kushnir V, Shaker A, Brunt LM, Gyawali CP. The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery. Surg Endosc. 2012;26:3401–7.
Shaker A, Stoikes N, Drapekin J, Kushnir V, Brunt LM, Gyawali CP. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108:1706–12.
Martinucci I, Savarino EV, Pandolfino JE, Russo S, Bellini M, Tolone S, Tutuian R, Roman S, Furnari M, Frazzoni M, Macchia L, Savarino V, Marchi S, de Bortoli N. Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD. Neurogastroenterol Motil. 2016;28(2):243–50.
Omari TI, Dejaeger E, van Beckevoort D, Goeleven A, Davidson GP, Dent J, Tack J, Rommel N. A method to objectively assess swallow function in adults with suspected aspiration. Gastroenterology. 2011;140:1454–63.
Omari TI, Kritas S, Cock C, Besanko L, Burgstad C, Thompson A, Rommel N, Heddle R, et al. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol Motil. 2014;26:59–68.
Omari TI, Papathanasopoulos A, Dejaeger E, Wauters L, Scarpellini E, Vos R, Slootmaekers S, Seghers V, et al. Reproducibility and agreement of pharyngeal automated impedance manometry with videofluoroscopy. Clin Gastroenterol Hepatol. 2011;9:862–7.
Lin Z, Imam H, Nicodeme F, Carlson DA, Lin CY, Yim B, Kahrilas PJ, Pandolfino JE. Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit. Am J Physiol. 2014;307:G158–63. pii:ajpgi.00119.2014.
Rommel N, Van Oudenhove L, Tack J, Omari TI. Automated impedance manometry analysis as a method to assess esophageal function. Neurogastroenterol Motil. 2014;26:636–45.
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de Bortoli, N., Frazzoni, M., Savarino, E.V. (2017). Esophageal Motility Testing: The Present and the Future. In: Conigliaro, R., Frazzoni, M. (eds) Diagnosis and Endoscopic Management of Digestive Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-42358-6_13
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