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Related Experiment Video

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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals.

Arvind Rengarajan1, Benjamin D Rogers1, Zhiqin Wong2

  • 1Division of Gastroenterology, Washington University School of Medicine in St Louis, St Louis, Missouri.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|November 4, 2020
PubMed
Summary

Abnormal esophageal motility patterns are infrequent in healthy adults, with ineffective esophageal motility (IEM) being the most common. Thresholds for high-resolution manometry (HRM) metrics vary by system and position.

Keywords:
Distal Contractile IntegralDistal LatencyHigh-Resolution ManometryIntegrated Relaxation Pressure

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Methods

Background:

  • High-resolution manometry (HRM) is the gold standard for assessing esophageal and esophagogastric junction (EGJ) function.
  • Understanding normal esophageal motor patterns and metric thresholds is crucial for accurate diagnosis.

Purpose of the Study:

  • To determine the prevalence of abnormal esophageal motor patterns in asymptomatic individuals.
  • To establish optimal software metric thresholds for HRM systems.

Main Methods:

  • Analysis of 469 unique HRM studies from asymptomatic adults worldwide.
  • Standardized manual analysis using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI).
  • Application of Chicago Classification v3.0 criteria and assessment of normative thresholds using percentile values.

Main Results:

  • 74.6% of studies showed normal esophageal motility; achalasia was absent.
  • Ineffective esophageal motility (IEM) was the most prevalent abnormal pattern (15.1%), followed by EGJ outflow obstruction (5.3%).
  • Metric thresholds varied by HRM system and patient position (upright vs. supine), with lower DCI values than current thresholds.

Conclusions:

  • Motor abnormalities are uncommon in healthy individuals, primarily consisting of IEM.
  • Stringent criteria and supine positioning reduce the proportion of identified IEM.
  • HRM metric thresholds require standardization across systems and study positions.