American Gastroenterological AssociationAGA technical review on the clinical use of esophageal manometry
Section snippets
1994–2003: how has esophageal manometry changed?
Manometry is by nature a highly technical evaluation, more akin to physiologic studies than to endoscopic or radiographic ones. When optimally utilized and providing that physical principles and equipment characteristics are respected, a manometric examination provides an accurate description of esophageal contractile function. In general, manometric data are only as valid as the methodology used to acquire them.
The frequency content of esophageal contractile waves defines the required
Upper esophageal sphincter
The muscular elements of the upper esophageal sphincter (UES) are the cricopharyngeus, adjacent esophagus, and adjacent inferior constrictor. The cricopharyngeus inserts bilaterally to the inferior-lateral margins of the cricoid lamina, and the zone of maximal UES pressure is ≈1 cm in length at precisely this location.14 The closed sphincter has a slit-like configuration, with the cricoid lamina anterior and the cricopharyngeus making up the lateral and posterior walls. Thus, it is not
Role of esophageal manometry in clinical practice (1994–2003)
Manometry has evolved from a research tool to a diagnostic modality with wide availability. It is an excellent tool to define the integrity of peristalsis and EGJ function. However, by default, the clinical yield of esophageal manometry is limited to the detection of relatively few functional abnormalities: absent or weak peristalsis, disordered peristalsis, abnormalities of EGJ pressure, and impaired EGJ relaxation. Beyond these abnormalities, manometry also detects minor aberrations of
Manometry for the diagnosis of multisystem disease
Manometrically evident abnormalities of peristalsis and LES function can be associated with systemic diseases that affect smooth muscle or the autonomic nervous system. The pattern of dysfunction evident in scleroderma and other collagen vascular diseases is of diminished or absent peristalsis in the distal half to two thirds of the esophagus and diminished or absent LES pressure with preserved function in the proximal third of the esophagus and the UES.108 Clinically, this often results in
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Supported by grants RO1 DC00646 (to P.J.K.) and K23 DK062170-01 (to J.E.P.) from the Public Health Service.