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.