High-resolution esophageal manometry: using technical advances for clinical advantages.

BACKGROUND: High-resolution manometry (HRM) is a new technique to investigate the motor function of the esophagus. It differs from conventional manometry in recording pressures by solid state microtransducers at 12 points around the circumference at every centimeter of esophageal length, and displaying the data in pseudo-three-dimensional format using a topographic plot, where esophageal pressures within a given range are represented by different colors. RATIONALE: The large amount of data and the capacity to analyze and display it intuitively has afforded many new insights into esophageal dysfunction. Among these insights are the ability to distinguish three different subtypes of achalasia and predict their response to therapy, better understanding of the relationship between the lower esophageal sphincter (LES) and the crural diaphragm, the development of novel quantitative parameters to understand the nature of the dysfunction in non-specific esophageal motor disorders, and the elucidation of a newly described motility disorder characterized by failure of peristalsis at the transitional zone between the upper skeletal muscle and the more distal smooth muscle portion of the esophagus. It is also ideally suited to analysis of the effect of prokinetic medications. The method is quicker and less uncomfortable for patients and the analysis is visually appealing and intuitively comprehensible.
CONCLUSION: Despite these potential advantages, there are currently no data to demonstrate a clinical advantage in treatment. The results of such studies will be crucial to the acceptance of this novel technology.