Esophageal Manometry

Esophageal Manometry

Joseph R. Triggs, MD, PhD

John E. Pandolfino, MD, MSCI

High-resolution esophageal manometry (HREM) and subsequent interpretation using the Chicago Classification (CC) is the gold standard for the diagnosis of esophageal motility disorders.1 The procedure is performed by placing a catheter with a dense series of pressure sensors transnasally with the distal tip ending in the patient’s stomach. Test swallows are then performed and recorded assessing contractile timing and intraluminal pressures. HREM studies are displayed as pressure topography plots or Clouse plots, named after the individual who developed them.2,3 These plots place time on the x-axis, anatomic location on the y-axis, and pressure depicted as color, with warmer colors representing higher amplitudes. HREM replaced traditional line tracing manometry and has led to increased ease of use, uniformity, standardization of objective measures used in the diagnosis of motility disorders, improved interrater agreement, and improved diagnostic yield.4,5,6,7 Despite these advances, HREM is a diagnostic tool that requires special expertise and training to reliably perform high quality studies.8,9,10 Healthcare professionals reading these studies must be able to assess for technical adequacy, which includes ensuring proper placement, recognizing common artifacts and equipment failure, in addition to being able to accurately report the measurements used in the CC to allow for an accurate diagnosis.


  • 1. HREM catheters are made by several manufacturers and manufacturer instructions should be followed for catheter calibration and recording device setup prior to patient arrival.

  • 2. Informed consent should be obtained and documented.11

  • 3. Patients should have nothing to eat or drink for at least 6 hours before the HREM study to prevent aspiration.

    • a. For patients with achalasia and esophageal retention, you may want to consider a clear liquid diet for 48 hours prior to the procedure.

  • 4. Patients should be assessed for prior foregut surgery as this can alter interpretation during analysis.

  • 5. The patient medication list should be reviewed specifically for opioids, calcium channel blockers, antispasmodics, nitroglycerin, and muscle relaxants as these can alter study results.

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Esophageal Manometry

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