High resolution manometry and multichannel intraluminal impedance oesophageal manometry in clinical practice

Abstract

The past decade has seen new technological advances in the investigation of oesophageal motility disorders. Multichannel intraluminal impedance monitoring has been used as an adjunct to conventional manometry in the assessment of oesophageal function, independent of radiography. High resolution manometry provides additional information over conventional manometry, and its topographic analysis makes interpretation of studies easier. Both utilities in non-obstructive dysphagia have been used ultimately in research; however, more studies are addressing their clinical application.

Figure 1

Bolus entry is considered at the 50% decrease in impedance from baseline relative to nadir and bolus exit is considered at the 50% recovery point from nadir to baseline.

Figure 2

Schematic representation of the nine channel catheter used in multichannel intraluminal impedance-oesophageal manometry. LOS, lower oesophageal sphincter; P, pressure transducer (circumferential transducers represented by bars, unidirectional transducers represented by circles); Z, impedance measuring segment (each measuring segment is made up of two impedance rings, placed 2 cm apart).

Figure 3

Two examples of tracings form multichannel intraluminal impedance-oesophageal manometry (MII-OM) testing are shown. (A) MII-OM in a normal patient. The impedance portion demonstrates bolus clearance with entry and exit at each site above the lower oesophageal sphincter (LOS). The manometry portion demonstrates normal oesophageal body contractions at each site with normal LOS relaxation. (B) MII-OM in a scleroderma patient. The impedance portion demonstrates incomplete exits in all three sites (ie, 15, 10 and 5 cm above the LOS). The manometry portion demonstrates normal contraction amplitude in the most proximal site but low contraction amplitudes in the remaining sites. OS relaxation pressure is also lower than normal.

Figure 4

An example of a normal high resolution manometry spatiotemporal plot. The final topographic analysis of each swallow demonstrates that oesophageal perisitalsis is not seamless but made up of four separate pressure segmental events and three pressure troughs. Courtesy of Pandolfino and colleagues (modified). LOS, lower oesophageal sphincter; UOS, upper oesophageal sphincter.