Esophageal manometry.docx

1、Esophageal manometryGI Motility online (2006)Esophageal manometryRichard H. Holloway, B.Sc. (Med), M.B.B.S., M.D., F.R.A.C.P.Key Points Esophageal manometry remains the gold standard for the assessment of esophageal motor activity. However, it is not a primary investigation and should be performed o

2、nly when the diagnosis has not been achieved by careful history, barium radiology, or endoscopy. The most rewarding indication for esophageal manometry is dysphagia. There are two main types of manometric recording systems: perfused and solid state. Both have strengths and weaknesses, and the choice

3、 of any particular system depends on how these strengths and weaknesses are viewed. Optimal recording of either pharyngeal or esophageal motility requires an array of multiple recording points that span the whole region of interest in order to provide an integrated picture of motor function. Perform

4、ance of accurate and high-fidelity manometric recordings requires a thorough understanding of how the manometric system operates as well as careful attention to technique. Poor-quality recordings inevitably lead to erroneous interpretation. The major elements of the analysis of pharyngoesophageal ma

5、nometry are the degree of upper esophageal sphincter relaxation, the integrity of pharyngal peristalsis, and intrabolus pressure. The major elements of the analysis of esophageal motor function are the integrity of esophageal peristalsis and the degree of lower esophageal relaxation. A structured an

6、d systematic assessment of these elements should lead to a manometric diagnosis Achalasia, diffuse esophageal spasm, and nonspecific motor disorders have distinct manometric features.IntroductionDisordered pharyngeal and esophageal motor function is a common cause of symptoms, particularly dysphagia

7、, chest pain, and those associated with gastroesophageal reflux. Motor function can be assessed by a variety of recording techniques including radiology, scintigraphy manometry, and most recently intraluminal electrical impedance monitoring. Some of these are complementary. The gold standard, howeve

8、r, for the assessment of motor disorders remains manometry. Manometric measurement of esophageal pressure is the most direct method for assessment of motor function. Only manometry can give information on the strength of contractions. But manometry also has its disadvantages. In assessing the conseq

9、uences of motility, the movement of intraluminal content is only by inference. However, when the diagnosis requires information about intraluminal flow, this can be obtained by complementary measurement of transit by radiology, scintigraphy, or intraluminal impedance monitoring.Over recent years, es

10、ophageal manometry has become a remarkably sophisticated technique. Technical advances have led to the development of a variety of recording equipment and approaches to manometric measurements and their analysis. The development of powerful computerized acquisition systems, along with high-fidelity

11、multichannel perfusion pumps and manometric catheters, has enabled high-resolution measurement and display of esophageal motility.Performance of technically adequate manometric recordings and interpretation of the findings requires considerable background knowledge. There have been four technical re

12、ports on esophageal manometry.1, 2, 3, 4 This review describes the principal elements of the manometric system, the approaches to the measurements themselves, the clinical application of the techniques, and the manometric features of common pharyngeal and esophageal motor disorders.Manometric Method

13、sManometric EquipmentA number of options are available for the performance of esophageal manometry. All are capable of obtaining adequate recordings, and the choice of any particular system depends ultimately on how these strengths and weaknesses are viewed. There are two major choices: systems that

14、 depend on assemblies that incorporate intraluminal solid-state transducers, and those that use perfused assemblies connected to external transducers. Both methods when used properly give accurate measurements of esophageal pressures. However, only intraluminal transducers can record accurately the

15、amplitude of pharyngeal pressures although the clinical value of these has yet to be demonstrated.Perfused Manometric SystemsPerfused manometric systems rely on the transmission of the intraluminal pressures to external pressure transducers along manometric assemblies perfused usually with distilled

16、 water.5 They have a number of advantages over assemblies composed of intraluminal transducers. They can readily incorporate a large number (currently up to 21) of recording points in order to provide high-resolution pressure recordings.6, 7, 8 These recording points can be arranged in a wide variety of configurations that can be tailored to specific recording applications, for example, pharyngeal, esophageal, gastroduodenal, and anorectal motilit