TY - JOUR
T1 - High-resolution manometry in clinical practice
T2 - Utilizing pressure topography to classify oesophageal motility abnormalities
AU - Pandolfino, J. E.
AU - Fox, M. R.
AU - Bredenoord, A. J.
AU - Kahrilas, P. J.
PY - 2009/8
Y1 - 2009/8
N2 - High-resolution manometry capable of pressure monitoring from the pharynx to the stomach together with pressure topography plotting represents an unquestionable evolution in oesophageal manometry. However, with this advanced technology come challenges and one of those is devising the optimal scheme to apply high-resolution oesophageal pressure topography (HROPT) to the clinical evaluation of patients. The first iteration of the Chicago classification was based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. This review summarizes the analysis process as it has evolved. Individual swallows are analysed in a stepwise fashion for the morphology of the oesophagogastric junction (OGJ), the extent of OGJ relaxation, the propagation velocity of peristalsis, the vigour of the peristaltic contraction, and abnormalities of intrabolus pressure utilizing metrics that have now been customized to HROPT. These results are then synthesized into a comprehensive diagnosis that, although based on conventional manometry criteria, is also customized to HROPT measures. The resultant classification objectifies the identification of three unique subtypes of achalasia. Additionally, it provides enhanced detail in the description of distal oesophageal spasm, nutcracker oesophagus subtypes, and OGJ obstruction. It is our expectation that modification of this classification scheme will continue to occur and this should further clarify the utility of pressure topography plotting in assessing oesophageal motility disorders.
AB - High-resolution manometry capable of pressure monitoring from the pharynx to the stomach together with pressure topography plotting represents an unquestionable evolution in oesophageal manometry. However, with this advanced technology come challenges and one of those is devising the optimal scheme to apply high-resolution oesophageal pressure topography (HROPT) to the clinical evaluation of patients. The first iteration of the Chicago classification was based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. This review summarizes the analysis process as it has evolved. Individual swallows are analysed in a stepwise fashion for the morphology of the oesophagogastric junction (OGJ), the extent of OGJ relaxation, the propagation velocity of peristalsis, the vigour of the peristaltic contraction, and abnormalities of intrabolus pressure utilizing metrics that have now been customized to HROPT. These results are then synthesized into a comprehensive diagnosis that, although based on conventional manometry criteria, is also customized to HROPT measures. The resultant classification objectifies the identification of three unique subtypes of achalasia. Additionally, it provides enhanced detail in the description of distal oesophageal spasm, nutcracker oesophagus subtypes, and OGJ obstruction. It is our expectation that modification of this classification scheme will continue to occur and this should further clarify the utility of pressure topography plotting in assessing oesophageal motility disorders.
KW - Achalasia
KW - Distal oesophageal spasm
KW - High-resolution manometry
KW - Nutcracker oesophagus
UR - http://www.scopus.com/inward/record.url?scp=68249135152&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68249135152&partnerID=8YFLogxK
U2 - 10.1111/j.1365-2982.2009.01311.x
DO - 10.1111/j.1365-2982.2009.01311.x
M3 - Review article
C2 - 19413684
AN - SCOPUS:68249135152
SN - 1350-1925
VL - 21
SP - 796
EP - 806
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 8
ER -