The role of high-resolution manometry in a resource challenged service

Oesophageal high-resolution manometry (HRM) is commonly used in the evaluation of patients presenting with upper gastrointestinal tract symptoms where primary oesophageal motility disorders are suspected. At our hospital, one doctor can perform and interpret HRM, with the hospital serving a population of approximately 3 million people. There is a paucity of data on HRM findings in South Africa.

This study included data from patients that underwent HRM between January 2018 and January 2023, using the hospitals electronic note-keeping system to access records. High-resolution manometry was performed for all patients using a water state catheter with 24 pressure channels. The Chicago classification version 3 was used for reporting.

A total of 210 patients were included in this study. The average age of patients included was 50 years (standard deviation [s.d.] ± 15.2) old with a female predominance (n = 149, 71.0%). Indications included gastroesophageal reflux disease (GORD) (65.7%), refractory heartburn (62.4%), dysphagia (37.6%), non-cardiac chest pain (16.7%), pre-procedurally (5.7%) and post-procedurally (14.8%). Many primary oesophageal motility disorders were observed, including ineffective oesophageal motility (20%), achalasia (11.4%), absent contractility (4.3%), oesophagogastric junction outflow obstruction (1.9%) and jackhammer oesophagus (1%). Normal findings accounted for 61%. The most common type of achalasia was type 1 (n = 16, 66%).

This study, being the first of its kind in South Africa, highlights the role of HRM in the diagnosis of primary oesophageal motility disorders with ineffective oesophageal motility being the most common pathology and GORD being the most common indication for HRM. Achalasia type 1 was the common type diagnosed.

HRM, despite its scarce availability, remains an important diagnostic tool in evaluating gastrointestinal pathologies.