High-Resolution Manometry and Esophageal Pressure Topography

Esophageal manometry is the primary method to evaluate esophageal motility, done by measuring pressures along the esophagus during test swallows. High-resolution manometry (HRM) and esophageal pressure topography (EPT) provide for a detailed evaluation of esophageal motor function, facilitated by objective metrics applied for interpretation guided by a consensus-generated classification scheme, the Chicago Classification. This chapter discusses the use and interpretation of HRM/EPT. Interpretation of HRM/EPT studies can be performed in a stepwise, hierarchical fashion as described by the Chicago Classification working group. An initial step in interpreting an HRM study involves assessing the technical adequacy of the study, which includes confirming intragastric catheter placement by identification of the pressure inversion point. After all test swallows are classified, an esophageal motility diagnosis can be generated according to the Chicago Classification, which provides a hierarchical framework. The standardized performance of HRM testing allows for reliable application of the Chicago Classification and generalization among clinical practices.