Section: UGI Sub-section: Oesophagus Curriculum: Curriculum, page 95
- Gold standard tool for assessment of oesophageal motor function
- Up to 36 sensors, < 2cm apart
- Map and characterise peristalsis
- Determine resting and functional pressures of sphincters
- Generates 3D representation
- Time = x axis
- Position = y axis
- Amplitude (pressure mmHg) = colour
Normal swallow, note synchronous relaxation of UES and LOS (diglutitive inhibition)
Metrics in Manometry
- IRP – Integrated Relaxation Pressure
- Assessment of GOJ relaxation
- DCI – Distal Contractile Integral
- Measurement of overall peristaltic contraction force
- Distal Latency
- Measurement of presence/absence of premature contractions/spasm
| Relaxation pressure across the esophago-gastric junction in response to deglutition | Integrated relaxation pressure (IRP) | Mean of the 4s of maximal deglutitive relaxation in the 10-s window beginning at UES relaxation, contiguous or non-contiguous, referenced to gastric pressure | Abnormal deglutitive IRP relaxation: - Supine median IRP ≥ 15mmHg (Medtronic) - Supine median IRP ≥ 22mmHg (Laborie/Diversatek) - Upright median IRP ≥ 12mmHg (Medtronic) - Upright median IRP ≥ 15mmHg (Laborie/Diversatek) | IRP > 12mmHg (Medtronic) on rapid drink challenge (RDC) or IRP > 25mmHg (Medtronic) on solid test meal supports outflow obstruction |
| Esophageal peristalsis | Distal Contractile Integral (DCI) – Contractile Vigor | Amplitude × duration × length (mmHg·s·cm) of the distal esophageal contraction exceeding 20 mmHg from the transition zone to the proximal margin of the LES | - Normal Contraction: DCI 450 to 8,000 mmHg·s·cm - Weak Contraction: DCI ≥ 100 and < 450 mmHg·s·cm - Failed Peristalsis: DCI < 100 mmHg·s·cm - Hypercontractile Swallow: DCI > 8,000 mmHg·s·cm - Ineffective Swallow: weak contraction or failed peristalsis | Intact contractile response on multiple rapid swallow (MRS): DCI < 100 mmHg·s·cm during MRS and DCI greater than single swallow mean DCI following MRS |
| Contractile Wavefront Integrity | Contiguity of peristalsis in an isobaric contour of 20 mmHg | Ineffective Swallow: Peristaltic break greater than 5cm in setting of a DCI ≥ 450 mmHg·s·cm | ||
| Latency of deglutitive inhibition | Distal latency (DL) | Interval between UES relaxation and CDP | - Premature/Spastic contraction: DL < 4.5 seconds in setting of a DCI ≥ 450 mmHg·s·cm | |
| Pressurization | Isobaric Contour | - Panesophageal pressurization: isobaric contour of ≥30mmHg - Intrabolus pressurization: isobaric contour of ≥20mmHg in the supine position (Medtronic) | Panesophageal pressurization >20mmHg on RDC or solid test meal supports outflow obstruction |