Rena Yadlapati1, Glenn T Furuta2, Paul Menard-Katcher3. 1. University of Colorado Reflux & Esophageal Diseases Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Academic Office 1 Room 7605, 12631 E. 17th Ave, Aurora, CO, 80045, USA. Rena.yadlapati@ucdenver.edu. 2. Digestive Health Institute, Children's Hospital Colorado, Aurora, CO; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, CO, USA. 3. University of Colorado Reflux & Esophageal Diseases Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Academic Office 1 Room 7605, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
Abstract
PURPOSE OF REVIEW: The purpose of this review is to present the latest developments in esophageal motility testing and summarize the current paradigm of esophageal motility disorders. RECENT FINDINGS: While high-resolution esophageal pressure topography interpreted according to the Chicago Classification represents the gold standard to evaluate esophageal motility, recent studies highlight the additional value of novel manometric applications. Novel applications include provocative measures to assess for obstructive physiology at the esophagogastric junction (EGJ), esophageal peristaltic reserve, and rumination and supragastric belching disorders. Furthermore, high-resolution impedance manometry provides assessment of bolus flow in relation to pressure changes. Distinct from manometry, the endolumenal functional lumen imaging probe examines esophageal motor response to distension to provide complementary and alternative data with regard to EGJ function and esophageal body motor function. Barium esophagram with timed swallow and barium tablet continues to be an important esophageal motility test. Furthermore, current use of multichannel intraluminal impedance-pH monitoring extends beyond reflux monitoring to measure reflux clearance and esophageal epithelial integrity. The diagnostic armamentarium for esophageal motility disorders has expanded tremendously to include a multitude of sophisticated tools. Advancements in diagnostic technology and understanding of esophageal physiology have shifted the field to more precisely characterize esophageal motility and guide phenotype-driven management.
PURPOSE OF REVIEW: The purpose of this review is to present the latest developments in esophageal motility testing and summarize the current paradigm of esophageal motility disorders. RECENT FINDINGS: While high-resolution esophageal pressure topography interpreted according to the Chicago Classification represents the gold standard to evaluate esophageal motility, recent studies highlight the additional value of novel manometric applications. Novel applications include provocative measures to assess for obstructive physiology at the esophagogastric junction (EGJ), esophageal peristaltic reserve, and rumination and supragastric belching disorders. Furthermore, high-resolution impedance manometry provides assessment of bolus flow in relation to pressure changes. Distinct from manometry, the endolumenal functional lumen imaging probe examines esophageal motor response to distension to provide complementary and alternative data with regard to EGJ function and esophageal body motor function. Barium esophagram with timed swallow and barium tablet continues to be an important esophageal motility test. Furthermore, current use of multichannel intraluminal impedance-pH monitoring extends beyond reflux monitoring to measure reflux clearance and esophageal epithelial integrity. The diagnostic armamentarium for esophageal motility disorders has expanded tremendously to include a multitude of sophisticated tools. Advancements in diagnostic technology and understanding of esophageal physiology have shifted the field to more precisely characterize esophageal motility and guide phenotype-driven management.
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