Updates in Surgery

, Volume 66, Issue 3, pp 177–181 | Cite as

High-resolution manometry for the evaluation of gastric motility

  • Fernando Augusto Mardiros Herbella
  • Lilian R. O. Aprile
  • Marco G. Patti
Review Article


This review focus on the utility of HRM for the evaluation of gastric motility. The evaluation of gastric motility has clinical implications for the study of a myriad of diseases. Disordered motility represents a spectrum of dysfunction ranging from delayed gastric emptying to abnormally rapid gastric transit. Gastric motility may be measured by a variety of methods with different efficacy and different variables that may be obtained. High-resolution manometry was created and added to the diagnostic armamentarium. The methods and outcomes for the study of proximal motility that may be useful to assess the thoracoabdominal pressure gradient, gastric filling and accommodation are described. Also, studies on antroduodenal manometry are reviewed. High-resolution manometry allows gastric manometry without technical limitations found on conventional manometry; however, studies are still on the phase of understanding the normal findings.


Stomach High-resolution manometry Motility 


Conflict of interest

No author declared conflict of interest.


  1. 1.
    Rostas JW 3rd, Mai TT, Richards WO (2011) Gastric motility physiology and surgical intervention. Surg Clin North Am 91(5):983–999. doi: 10.1016/j.suc.2011.06.012 PubMedCrossRefGoogle Scholar
  2. 2.
    Chapman MJ, Nguyen NQ, Deane AM (2011) Gastrointestinal dysmotility: clinical consequences and management of the critically ill patient. Gastroenterol Clin North Am 40(4):725–739PubMedCrossRefGoogle Scholar
  3. 3.
    Rauch S, Krueger K, Turan A, You J, Roewer N, Sessler DI (2012) Use of wireless motility capsule to determine gastric emptying and small intestinal transit times in critically ill trauma patients. J Crit Care 27(5):534.e7–e12Google Scholar
  4. 4.
    Rao SS, Camilleri M, Hasler WL et al (2011) Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil 23(1):8–23. doi: 10.1111/j.1365-2982.2010.01612.x PubMedCrossRefGoogle Scholar
  5. 5.
    Devanarayana NM, Rajindrajith S, Rathnamalala N, Samaraweera S, Benninga MA (2012) Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III criteria for functional abdominal pain. Neurogastroenterol Motil 24(5):420–425 (e207)PubMedCrossRefGoogle Scholar
  6. 6.
    Fruehauf H, Menne D, Kwiatek MA et al (2011) Inter-observer reproducibility and analysis of gastric volume measurements and gastric emptying assessed with magnetic resonance imaging. Neurogastroenterol Motil 23(9):854–861PubMedCrossRefGoogle Scholar
  7. 7.
    Bharucha AE, Manduca A, Lake DS et al (2011) Gastric motor disturbances in patients with idiopathic rapid gastric emptying. Neurogastroenterol Motil 23(7):617 (e252)PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Saad RJ, Hasler WL (2011) A technical review and clinical assessment of the wireless motility capsule. Gastroenterol Hepatol (N Y) 7(12):795–804Google Scholar
  9. 9.
    Parkman HP (2012) Scintigraphy for evaluation of patients for GI motility disorders—the referring physician’s perspective. Semin Nucl Med 42(2):76–78PubMedCrossRefGoogle Scholar
  10. 10.
    Szarka LA, Camilleri M (2009) Methods for measurement of gastric motility. Am J Physiol Gastrointest Liver Physiol 296(3):G461–G475PubMedCrossRefGoogle Scholar
  11. 11.
    Savoye G, Brung-Lefebvre M, Bouin M, Maillot C, Denis P, Ducrotté P (2007) Effects of ondansetron on gastric tone and motility changes induced by a prolonged intraduodenal infusion of nutrients. Results of a placebo-controlled study. Dig Dis Sci 52(10):2676–2683PubMedCrossRefGoogle Scholar
  12. 12.
    Salvador R, Dubecz A, Polomsky M et al (2009) A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry. J Am Coll Surg 208(6):1035–1044PubMedCrossRefGoogle Scholar
  13. 13.
    Mittal RK, Padda B, Bhalla V, Bhargava V, Liu J (2006) Synchrony between circular and longitudinal muscle contractions during peristalsis in normal subjects. Am J Physiol Gastrointest Liver Physiol 290(3):G431–G438 (Epub 2005 Oct 6)PubMedCrossRefGoogle Scholar
  14. 14.
    Dinning PG, Arkwright JW, Costa M, Wiklendt L, Hennig G, Brookes SJ, Spencer NJ (2011) Temporal relationships between wall motion, intraluminal pressure, and flow in the isolated rabbit small intestine. Am J Physiol Gastrointest Liver Physiol 300(4):G577–G585. doi: 10.1152/ajpgi.00532.2010 PubMedCrossRefGoogle Scholar
  15. 15.
    Herbella FA, Patti MG (2010) Gastroesophageal reflux disease: from pathophysiology to treatment. World J Gastroenterol 16(30):3745–3749PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Lord RV, DeMeester SR, Peters JH et al (2009) Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of Nissen fundoplication in the spectrum of gastroesophageal reflux disease. J Gastrointest Surg 13(4):602–610PubMedCrossRefGoogle Scholar
  17. 17.
    Crookes PF (2006) Physiology of reflux disease: role of the lower esophageal sphincter. Surg Endosc 20(2):S462–S466PubMedCrossRefGoogle Scholar
  18. 18.
    Pandolfino JE, Ghosh SK, Zhang Q, Jarosz A, Shah N, Kahrilas PJ (2006) Quantifying EGJ morphology and relaxation with high-resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol 290(5):G1033–G1040 (Epub 2006 Feb 2)PubMedCrossRefGoogle Scholar
  19. 19.
    Ayazi S, DeMeester SR, Hsieh CC et al (2011) Thoraco-abdominal pressure gradients during the phases of respiration contribute to gastroesophageal reflux disease. Dig Dis Sci 56(6):1718–1722PubMedCrossRefGoogle Scholar
  20. 20.
    Aimi M, Furuta K, Saito T et al (2012) Influence of Full-body Water Immersion on Esophageal Motor Function and Intragastric Pressure. J Neurogastroenterol Motil 18(2):194–199. doi: 10.5056/jnm.2012.18.2.194 PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ (2006) Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 130(3):639–649PubMedCrossRefGoogle Scholar
  22. 22.
    Pauwels A, Blondeau K, Dupont LJ, Sifrim D (2012) Mechanisms of increased gastroesophageal reflux in patients with cystic fibrosis. Am J Gastroenterol 107(9):1346–1353. doi: 10.1038/ajg.2012.213 PubMedCrossRefGoogle Scholar
  23. 23.
    Pandolfino JE, Zhang QG, Ghosh SK, Han A, Boniquit C, Kahrilas PJ (2006) Transient lower esophageal sphincter relaxations and reflux: mechanistic analysis using concurrent fluoroscopy and high-resolution manometry. Gastroenterology 131(6):1725–1733 (Epub 2006 Sep 8)PubMedCrossRefGoogle Scholar
  24. 24.
    Pandolfino JE, Ghosh SK, Lodhia N, Kahrilas PJ (2008) Utilizing intraluminal pressure gradients to predict esophageal clearance: a validation study. Am J Gastroenterol 103(8):1898–1905. doi: 10.1111/j.1572-0241.2008.01913.x PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJ (2013) Normal values for esophageal high-resolution manometry. Neurogastroenterol Motil 25(9):762. doi: 10.1111/nmo.12167 PubMedCrossRefGoogle Scholar
  26. 26.
    Mali J Jr, Fernandes FA, Valezi AC, Matsuo T, Menezes Mde A (2010) Influence of the actual diameter of the gastric pouch outlet in weight loss after silicon ring Roux-en-Y gastric bypass: an endoscopic study. Obes Surg 20(9):1231–1235PubMedCrossRefGoogle Scholar
  27. 27.
    Ardila-Hani A, Soffer EE (2011) Review article: the impact of bariatric surgery on gastrointestinal motility. Aliment Pharmacol Ther 34(8):825–831PubMedCrossRefGoogle Scholar
  28. 28.
    Burton PR, Brown W, Laurie C et al (2009) The effect of laparoscopic adjustable gastric bands on esophageal motility and the gastroesophageal junction: analysis using high-resolution video manometry. Obes Surg 19(7):905–914PubMedCrossRefGoogle Scholar
  29. 29.
    Burton PR, Brown WA, Laurie C et al (2010) Pathophysiology of laparoscopic adjustable gastric bands: analysis and classification using high-resolution video manometry and a stress barium protocol. Obes Surg 20(1):19–29PubMedCrossRefGoogle Scholar
  30. 30.
    Ang D (2011) Measurement of gastric accommodation: a reappraisal of conventional and emerging modalities. Neurogastroenterol Motil 23(4):287–291PubMedCrossRefGoogle Scholar
  31. 31.
    Janssen P, Verschueren S, Ly HG, Vos R, van Oudenhove L, Tack J (2011) Intragastric pressure during food intake: a physiological and minimally invasive method to assess gastric accommodation. Neurogastroenterol Motil 23:316–323PubMedCrossRefGoogle Scholar
  32. 32.
    Pauwels A, Altan E, Tack J (2014) The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease. Neurogastroenterol Motil 26(4):581–588. doi: 10.1111/nmo.12305 PubMedCrossRefGoogle Scholar
  33. 33.
    Janssen P, Verschueren S, Tack J (2012) Intragastric pressure as a determinant of food intake. Neurogastroenterol Motil 24:612 (e268)PubMedCrossRefGoogle Scholar
  34. 34.
    Schaub N, Ng K, Kuo P, Aziz Q, Sifrim D (2014) Gastric and lower esophageal sphincter pressures during nausea: a study using visual motion-induced nausea and high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 306(9):G741–G747. doi: 10.1152/ajpgi.00412.2013 PubMedCrossRefGoogle Scholar
  35. 35.
    Roman S, Marjoux S, Thivolet C, Mion F (2014) Oesophageal function assessed by high-resolution manometry in patients with diabetes and inadequate glycaemic control. Diabet Med. doi: 10.1111/dme.12476 PubMedGoogle Scholar
  36. 36.
    Herbella FA, Vicentine FP, Silva LC, Patti MG (2011) Postprandial proximal gastric acid pocket and gastroesophageal reflux disease. Dis Esophagus. doi: 10.1111/j.1442-2050.2011.01293.x Google Scholar
  37. 37.
    Hila A, Bouali H, Xue S, Knuff D, Castell DO (2006) Postprandial stomach contents have multiple acid layers. J Clin Gastroenterol 40:612–617PubMedCrossRefGoogle Scholar
  38. 38.
    Herbella FA, Vicentine FP, Del Grande JC, Patti MG (2011) Postprandial proximal gastric acid pocket and gastric pressure in patients after gastric surgery. Neurogastroenterol Motil 23(1):52–55PubMedCrossRefGoogle Scholar
  39. 39.
    Indireshkumar K, Brasseur JG, Faas H et al (2000) Relative contributions of “pressure pump” and “peristaltic pump” to gastric emptying. Am J Physiol Gastrointest Liver Physiol 278(4):G604–G616PubMedGoogle Scholar
  40. 40.
    Friedenberg FK, Desipio J, Korimilli A et al (2008) Tonic and phasic pyloric activity in response to CCK-octapeptide. Dig Dis Sci 53(4):905–911PubMedCrossRefGoogle Scholar
  41. 41.
    Faas H, Hebbard GS, Feinle C, Kunz P, Brasseur JG, Indireshkumar K, Dent J, Boesiger P, Thumshirn M, Fried M, Schwizer W (2001) Pressure-geometry relationship in the antroduodenal region in humans. Am J Physiol Gastrointest Liver Physiol 281(5):G1214–G1220PubMedGoogle Scholar
  42. 42.
    Desipio J, Friedenberg FK, Korimilli A, Richter JE, Parkman HP, Fisher RS (2007) High-resolution solid-state manometry of the antropyloroduodenal region. Neurogastroenterol Motil 19(3):188–195PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Fernando Augusto Mardiros Herbella
    • 1
  • Lilian R. O. Aprile
    • 2
  • Marco G. Patti
    • 3
  1. 1.Department of Surgery, Escola Paulista de Medicina, Division of Esophagus and Stomach, Surgical GastroenterologyFederal University of Sao Paulo, Hospital Sao PauloSao PauloBrazil
  2. 2.Department of MedicineUniversity of São Paulo at Ribeirão PretoRibeirão PretoBrazil
  3. 3.Department of SurgeryUniversity of ChicagoChicagoUSA

Personalised recommendations