Advancements in the use of manometry and impedance testing for esophageal functional disorders

ABSTRACT

Introduction. The utilization of high-resolution manometry (HRM) has enhanced our understanding and assessment of esophageal motor disorders. Moreover, the combination of impedance technology with HRM (HRIM) has further improved our knowledge of esophageal physiology and the clinical evaluation of dysmotility, thanks to the addition of accurate measurement of bolus transit.

Areas covered. This paper provides an overview of current knowledge in the use of HRIM for the study of esophageal functional disorders by reporting mainly the results of many publications and several systematic reviews in this field.

Expert opinion. HRIM has represented a relevant improvement in the assessment of esophageal motility and has required the development of new metrics, such as the esophageal impedance integral ratio, the bolus flow time, the nadir impedance pressure and the impedance bolus height, which increase the evaluation of esophageal bolus transit. An extension of impedance is represented by functional lumen imaging probe (FLIP), which determines the biophysical properties and the distensibility of the esophagus and permits to detect contractility patterns not seen on HRM alone. We eagerly wait for a new and fruitful iteration of the Chicago Classification, now in version 3.0, which can cover the ongoing clinical experience of HRIM.

KEYWORDS:

• Chicago Classification
• esophageal motor disorders
• high-resolution manometry
• HRM combined with impedance
• impedance technology
• manometric evaluation
• esophageal function

Highlights box

1. Manometry currently represents the gold standard to assess motor function of the esophagus and the superior diagnostic yield of high-resolution manometry (HRM) over conventional manometry has been demonstrated.

2. The combination of HRM and impedance (HRIM) has the advantage of measuring bolus transit in addition to esophageal body contractions.

3. HRIM has contributed to define several parameters of the Chicago Classification for esophageal motor disorders and the development of new metrics, such as esophageal impedance integral ratio, bolus flow time, nadir impedance pressure and impedance bolus height, have improved the evaluation of esophageal bolus transit.

4. The study of esophageal distensibility with the use of functional lumen imaging probe (FLIP) complete the assessment of esophageal function.

5. HRIM is helpful for distinguishing supragastric from gastric belching and rumination from regurgitation episodes. The above new metrics are also useful to better define the alterations of esophago-gastric junction in achalasia and gastroesophageal reflux disease.

6. It is likely that HRIM measurements will be incorporated into future versions of the Chicago Classification in order to enhance esophageal function analysis in patients without major motor alterations.

Declaration of interest

S. Edoardo has served as a consultant and paid speaker for Takeda, Janssen, MSD, Abbvie, Sofar, Melesci, Reckitt Benckiser and Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.