High-resolution manometry and assessment of esophageal reflux

Esophageal high-resolution manometry (HRM) represents a significant advance over conventional esophageal manometry that is more time-efficient for both the operator and the patient. Further, the procedure quality is improved as the real-time data are available for the operator, and the procedure is less cumbersome because of the elimination of the stationary pull through maneuver. Achalasia diagnosis has improved sensitivity, and the technique has improved description and classification of motor disorders. While conventional catheter based pH systems remain in vogue, wireless pH probes can now be placed in the esophagus with better patient tolerance, and improved diagnostic gain in select situations. Impedance monitoring allows identification of reflux events irrespective of pH, a technology that can be combined with catheter-based pH monitoring. Anorectal manometry has now incorporated both the high resolution and 3-D technology that provides better definition of anorectal sphincter mechanisms. Research is ongoing to determine how these advances impact patient management and clinical outcome.