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New Developments in Esophageal Motility Testing

  • Rena YadlapatiEmail author
  • Glenn T. Furuta
  • Paul Menard-Katcher
Esophagus (PG Iyer, Section Editor)
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Part of the following topical collections:
  1. Topical Collection on Esophagus

Abstract

Purpose of review

The purpose of this review is to present the latest developments in esophageal motility testing and summarize the current paradigm of esophageal motility disorders.

Recent findings

While high-resolution esophageal pressure topography interpreted according to the Chicago Classification represents the gold standard to evaluate esophageal motility, recent studies highlight the additional value of novel manometric applications. Novel applications include provocative measures to assess for obstructive physiology at the esophagogastric junction (EGJ), esophageal peristaltic reserve, and rumination and supragastric belching disorders. Furthermore, high-resolution impedance manometry provides assessment of bolus flow in relation to pressure changes. Distinct from manometry, the endolumenal functional lumen imaging probe examines esophageal motor response to distension to provide complementary and alternative data with regard to EGJ function and esophageal body motor function. Barium esophagram with timed swallow and barium tablet continues to be an important esophageal motility test. Furthermore, current use of multichannel intraluminal impedance-pH monitoring extends beyond reflux monitoring to measure reflux clearance and esophageal epithelial integrity.

Summary

The diagnostic armamentarium for esophageal motility disorders has expanded tremendously to include a multitude of sophisticated tools. Advancements in diagnostic technology and understanding of esophageal physiology have shifted the field to more precisely characterize esophageal motility and guide phenotype-driven management.

Keywords

Esophageal manometry pH monitoring FLIP Mucosal impedance Barium esophagram Esophageal physiology EGJ obstruction 

Abbreviations

FLIP

Functional luminal imaging probe

MII-pH

Multichannel intraluminal impedance-pH

HRM

High-resolution manometry

EPT

Esophageal pressure topography

EGJ

Esophagogastric junction

IRP

Integrated relaxation pressure

LES

Lower esophageal sphincter

POEM

Per-oral endoscopy myotomy

AGA

American Gastroenterological Association

HRIM

High-resolution impedance manometry

EII

Esophageal impedance integral

PPI

Proton pump inhibitor

EJG-DI

EGJ-distensibility index

RACs

Repetitive antegrade contractions

RRCs

Repetitive retrograde contractions

MNBI

Mean nocturnal baseline impedance

GERD

Gastroesophageal reflux disease

PSPW

Post-reflux swallow-induced peristaltic wave

Notes

Author Contributions

RY, GTF, PMK: literature review, manuscript drafting, and final review.

Compliance with Ethical Standards

Conflict of Interest

Rena Yadlapati is a consultant for Ironwood Pharmaceuticals, Diversatek, and Medtronic, and received grants from NIHNIDDK and the American College of Gastroenterology.

Glenn Furuta reports grants from NIHNIDDK and personal fees from Shire, outside the submitted workIn addition; Dr. Furuta has a patent (EnteroTrack) licensed, and a patent (UpToDate) with royalties paid. Paul Menard-Katcher declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclosures/Declaration of Funding

RY: Consultant for Ironwood, Diversatek Healthcare, Medtronic; supported by NIH R01 DK092217 (Pandolfino), and ACG Junior Faculty Development Award (Yadlapati).

GTF: NIH 1K24DK100303, consultant for Shire, co-founder of EnteroTrack, royalties from UpToDate.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rena Yadlapati
    • 1
    Email author
  • Glenn T. Furuta
    • 2
  • Paul Menard-Katcher
    • 1
  1. 1.University of Colorado Reflux & Esophageal Diseases Center, Division of Gastroenterology & Hepatology, Department of MedicineUniversity of ColoradoAuroraUSA
  2. 2.Digestive Health Institute, Children’s Hospital Colorado, Aurora, CO; Gastrointestinal Eosinophilic Diseases ProgramUniversity of Colorado School of MedicineAuroraUSA

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