Manometry of the gastrointestinal tract: toy or tool?

In the eyes of scientific researchers, there are various manometric techniques that are useful tools for studying the motility of the gastrointestinal tract. Clinicians, however, regard most of these techniques as toys, either because they do not lead to clinically relevant results, or because they are too cumbersome in clinical practice. Nevertheless, a number of manometric techniques have reached the status of clinically relevant diagnostic procedure in gastroenterology. Among these, oesophageal manometry is the most important. Not only has conventional oesophageal manometry been added to the diagnostic armamentarium of many hospitals, but also prolonged ambulatory recording of oesophageal pressures (usually combined with pH monitoring). Small intestinal manometry has also gained the status of a diagnostic tool, in particular in patients in whom the existence of pseudo-obstruction syndrome is suspected and in patients in whom total colectomy is considered because of intractable constipation. Sphincter of Oddi manometry is another example of a clinically relevant manometric technique to be used in particular in patients with suspected dyskinesia of the sphincter of Oddi. The value of anorectal manometry may have been overestimated in the past. The most important indication is the exclusion of Hirschsprung disease. The contribution of anorectal manometry to the diagnosis of anismus and to the work-up of patients with faecal incontinence is limited.