High‐resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry

TLDR

High‑resolution manometry (HRM) is a new oesophageal measurement technique whose clinical utility remains debated. The study compared the accuracy of HRM versus conventional manometry in predicting bolus transport and evaluated HRM’s clinical value in patients with endoscopy‑negative dysphagia where standard tests were non‑diagnostic. Researchers performed concurrent HRM and video‑fluoroscopy on controls and dysphagia patients, reviewed 95 recordings with HRM spatiotemporal and conventional line plots, and analyzed HRM data to uncover additional abnormalities. ROC analysis showed HRM more accurately predicted abnormal bolus transport and revealed clinically significant motor dysfunction—such as localized peristaltic disturbances and abnormal lower oesophageal sphincter movement during spasm—that conventional manometry and radiography missed.

Abstract

Abstract Background and aims: High‐resolution manometry (HRM) is a recent development in oesophageal measurement; its value in the clinical setting remains a matter of controversy. (i) We compared the accuracy with which bolus transport could be predicted from conventional manometry and HRM. (ii) The clinical value of HRM was assessed in a series of patients with endoscopy‐negative dysphagia in whom conventional investigations had been non‐diagnostic. Method: (i) Control subjects and patients with endoscopy‐negative dysphagia underwent concurrent HRM and video‐fluoroscopy. Ninety‐five records were reviewed using HRM with spatiotemporal plot and conventional line plots of the pressure data derived from the same recording. (ii) The HRM and notes of patients with endoscopy‐negative dysphagia and abnormal bolus transport were analysed to identify additional information provided by the new technique. Results: (i) Receiver operating characteristic analysis demonstrated that HRM predicts the presence of abnormal bolus transport more accurately than conventional manometry. (ii) HRM identified clinically important motor dysfunction not detected by manometry and radiography. These included localized disturbances of peristalsis and abnormal movement of the lower oesophageal sphincter during oesophageal spasm. Conclusion: The HRM predicts bolus movement more accurately than conventional manometry and identifies clinically relevant oesophageal dysfunction not detected by other investigations including conventional manometry.