Normal Values of High-resolution Manometry Parameters With Provocative Maneuvers.

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Imaging

Background:

• High-resolution manometry (HRM) protocols using single swallow types have limitations.
• Comprehensive HRM protocols incorporating diverse swallow challenges may offer improved diagnostic capabilities.

Purpose of the Study:

• To describe normal findings from a comprehensive high-resolution manometry (HRM) protocol.
• To establish normative data for various provocative swallow tests in asymptomatic individuals.

Main Methods:

• Thirty healthy asymptomatic volunteers underwent HRM with multiple swallow types: liquid (supine/upright), viscous, solid, multiple rapid swallows, and rapid drink challenge.
• HRM data were analyzed using the Chicago classification version 3.0.
• Integrated relaxation pressure (IRP) and contractile parameters were assessed across different swallow maneuvers.

Main Results:

• Median integrated relaxation pressure (IRP) varied significantly across swallow types, with lower values observed during upright liquid, viscous, solid, multiple rapid swallows, and rapid drink challenge compared to supine liquid swallows (P < 0.005).
• Elevated IRP values were noted in 27% of subjects on 1-2 maneuvers, but all subjects exhibited normal IRP (<12 mmHg) on at least one maneuver.
• Isolated abnormalities in IRP and contractile parameters were observed in 80% of asymptomatic subjects, yet all demonstrated normal features across the comprehensive study.

Conclusions:

• Normal values and characteristic findings for a comprehensive HRM protocol are established in healthy volunteers.
• The study highlights that isolated "abnormalities" in specific metrics are common in asymptomatic individuals.
• A recalibration of the "normal" definition for HRM is recommended, emphasizing the overall study findings rather than isolated parameter values.