Gastrointestinal manometry: a practical tool or a research technique?

Gastrointestinal motility disorders constitute a major segment of digestive illness. Therefore, measurement of gut motor activity should be a desired goal. However the practical usefulness of gastrointestinal manometry is controversial. In this report we review the theoretical, technical, and practical problems posed by gastrointestinal manometry in health and in disease. Special emphasis is put on aspects pertaining to the indications and clinical applicability of the technique. New methodological developments that allow measurement of motor functions of the proximal stomach and the antroduodenal junction are also examined. Gastrointestinal manometry is potentially helpful in the diagnostic evaluation of patients presenting with upper gastrointestinal symptoms without demonstrable anatomic alteration as evidence by conventional diagnostic evaluation. It may help to localize the affected region of the gut as well as to monitor the evolution of the motor disorder and to determine the effect of pharmacological treatment. For a complete evaluation of upper gastrointestinal motility it is important to record gastric activity at the same time as in the intestine, during fasting and also postprandially. Manometry may help to determine the type of abnormal motor pattern that occurs in a given motor disorder. However, at the present time no specific abnormalities for specific diseases have been described. Thus, alterations in upper gut motility due to lesions at different levels of the brain-gut axis (central nervous system, autonomic nervous system or myenteric plexus) may produce a similarly deranged manometric pattern. Moreover, relations between a particular motor abnormality and the symptoms that the patient complains of may be quite variable. Still, we conclude that measurement of gastrointestinal motility has matured and proven its value to an extent that its application to clinical gastroenterology in carefully selected instances is appropriate and timely.