Browse the corpus

The esophagus is a muscular tube that begins at the hypopharynx and ends at the stomach. The primary role of the esophagus is to transfer solids and liquids into the stomach. There is intricate coordination of esophageal striated and smooth muscles, allowing food bolus propagation. Problems arise when patients have difficulty swallowing or reflux of gastric contents. When abnormalities of the esophagus are suspected, tests can be utilized to examine the esophagus, including upper gastrointestinal (GI) swallow study, esophagogastroduodenoscopy (EGD), pH monitoring, and esophageal manometry (see Figure. Manometry in a Patient With Chagas). This topic focuses specifically on esophageal manometry. Esophageal manometry is the evaluation of the movement and pressure of the esophagus. Conventional esophageal manometry uses probes every 5 cm in the esophagus to measure contraction and pressure.[1] This was first utilized in the 1950s[1] and had been the gold standard for diagnosing esophageal motility disorders. Recently, this technology has advanced, and conventional esophageal manometry has been replaced by high-resolution esophageal manometry (HRM), which is the gold standard. (see Figure. Sample of High-Resolution Manometry). HRM uses a high-resolution catheter to transmit intraluminal pressure data that are subsequently converted into dynamic esophageal pressure topography (EPT) plots.[2] These transducer probes are located approximately every 1 cm in the esophagus on the catheter. After the catheter is placed in the esophagus, patients get a baseline measurement and then do 10 wet swallows. From this data, a motility diagnosis can be made according to the Chicago Classification (version 3.0).[3] Based on the diagnosis, different treatments can be perused.

Complications of HRM are rare. Placing the HRM nasogastric sensory catheter may cause discomfort in the nose or throat. During placement of the catheter, patients may experience a gagging sensation that may lead to emesis. Caution should be exercised when placing the catheter in patients who have recently had esophageal surgery or with esophageal varices. Finally, there have been rare instances of esophageal perforation in patients with severe achalasia during HRM.[19]