Abstract
Introduction
High-resolution manometry (HRM) is faster and easier to perform than conventional water perfused manometry. There is general acceptance of its usefulness in evaluating upper esophageal sphincter and esophageal body. There has been less emphasis on the use of HRM to evaluate the lower esophageal sphincter (LES) resting pressure and length, both factors important in LES barrier function. The aim of this study was to compare the resting characteristics of the LES determined by HRM and conventional manometry in the same patients.
Methods
We performed both HRM and conventional manometry including a slow motorized pull-through technique in 55 patients with foregut symptoms. The characteristics of the LES analyzed were: resting pressure, total length, and abdominal length. Four available modes of HRM analysis were used to assess resting characteristics of the LES: spatiotemporal mode using both abrupt color change and isobaric contour, line tracing, and pressure profile. The values obtained from these four HRM modes were then compared to the conventional manometry measurements.
Results
High-resolution manometry and conventional manometry did not differ in their measurement of LES resting pressure. LES overall and abdominal length were consistently overestimated by HRM. A variability up to 4 cm in overall length was observed and was greatest in patients with hiatal hernia (1.8 vs. 0.9 cm, p = 0.027).
Conclusion
The current construction of the catheter and software analysis used in high-resolution manometry do not allow precise measurement of LES length. Errors in the identification of the upper border of the sphincter may compromise accurate positioning of a pH probe.
Similar content being viewed by others
References
Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology 2008;135(3):756–769.
Campos GM, Oberg S, Gastal O, et al. Manometry of the lower esophageal sphincter: inter- and intraindividual variability of slow motorized pull-through versus station pull-through manometry. Dig Dis Sci 2003;48(6):1057–1061.
Ayazi S, Hagen JA, Chan LS, et al. Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms. J Gastrointest Surg 2009;13(8):1440–1447.
Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol 2000;95(10):2720–2730.
Takasaki K, Umeki H, Enatsu K, et al. Investigation of pharyngeal swallowing function using high-resolution manometry. Laryngoscope 2008;118(10):1729–1732.
Ghosh SK, Pandolfino JE, Zhang Q, et al. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 2006;291(3):G525–G531.
Pandolfino JE, Ghosh SK, Rice J, et al. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol 2008;103(1):27–37.
Kahrilas PJ, Ghosh SK, Pandolfino JE. Esophageal motility disorders in terms of pressure topography: the Chicago Classification. J Clin Gastroenterol 2008;42(5):627–635.
Pandolfino JE, Ghosh SK, Lodhia N, Kahrilas PJ. Utilizing intraluminal pressure gradients to predict esophageal clearance: a validation study. Am J Gastroenterol 2008;103(8):1898–1905.
Ayazi S, Lipham JC, Portale G, et al. Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol 2009;7(1):60–67.
Ayazi S, Leers JM, Oezcelik A, et al. Measurement of gastric pH in ambulatory esophageal pH monitoring. Surg Endosc 2009;23(9):1968–1973.
Mekapati J, Knight LC, Maurer AH, et al. Transsphincteric pH profile at the gastroesophageal junction. Clin Gastroenterol Hepatol 2008;6(6):630–634.
Pandolfino JE, Lee TJ, Schreiner MA, et al. Comparison of esophageal acid exposure at 1 cm and 6 cm above the squamocolumnar junction using the Bravo pH monitoring system. Dis Esophagus 2006;19(3):177–182.
Kahrilas PJ, Ghosh SK, Pandolfino JE. Challenging the limits of esophageal manometry. Gastroenterology 2008;134(1):16–18.
Stein HJ, DeMeester TR, Naspetti R, et al. Three-dimensional imaging of the lower esophageal sphincter in gastroesophageal reflux disease. Ann Surg. 1991;214(4):374–383.
Code CF, Fyke FE, Schlegel JF. The gastroesophageal sphincter in healthy human beings. Gastroenterologia 1956;86(3):135–150.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work has been designated as poster of distinction at the Digestive Diseases Week, June 2009, Chicago, IL.
Rights and permissions
About this article
Cite this article
Ayazi, S., Hagen, J.A., Zehetner, J. et al. The Value of High-Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter. J Gastrointest Surg 13, 2113–2120 (2009). https://doi.org/10.1007/s11605-009-1042-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-009-1042-0