Utilization trends for esophageal motility testing in the United States

Esophageal manometry is the cornerstone diagnostic test for esophageal motility disorders, yet national utilization patterns over time are poorly defined. The Functional Lumen Imaging Probe (FLIP) has emerged as a complementary modality, but its uptake relative to manometry remains unclear. We aimed to describe population-level utilization trends, patient characteristics, and clinical indications for esophageal manometry and FLIP in the United States. We conducted a retrospective cohort study using MarketScan Commercial Claims (<65 years; 2000-2023) and a 20% Medicare fee-for-service sample (≥65 years; 2007-2017). Manometry and FLIP were identified using Current Procedural Terminology 91010 and 91040 (available starting in 2016), respectively. Annual utilization rates per 100,000 enrollees were calculated. Clinical indications, downstream therapeutic interventions and additional diagnostic testing were identified using ICD-9/10 diagnosis codes. In the most recent years available, 4410 MarketScan and 3513 Medicare patients underwent manometry; FLIP use was lower (851 MarketScan; 48 Medicare). Manometry utilization increased substantially in Medicare, reaching 120 per 100,000 in 2017, while remaining stable in MarketScan (43 per 100,000 in 2023). FLIP use was lower than manometry, increased gradually in MarketScan but remained minimal in Medicare. Gastroesophageal reflux and dysphagia were the most common indications for manometry. Downstream therapeutic interventions were uncommon, whereas additional diagnostic testing and repeat motility assessments were frequent. Esophageal motility testing is increasingly used in U.S. practice, particularly among older adults. FLIP use remains less frequent than manometry. These findings provide essential context for understanding diagnostic strategies and optimizing high-value motility testing.