Manometry

Esophageal manometry has been in use for physiological measurement and diagnostics for many years. Solid-state esophageal high-resolution-manometry (E-HRM) offers the ability to record pressures from the upper esophageal sphincter to stomach with fidelity and high spatial resolution, and this has led to the definition of new objective biomechanical measures of esophageal function. For pediatric patients with typical gastroesophageal (GER) disease symptoms, E-HRM may help to guide clinical decision-making, the most important application being the pre-operative investigation of children undergoing workup for anti-reflux surgery. While performing E-HRM can be challenging in younger children, it can be used to exclude achalasia as a cause of typical symptoms and can provide a range of information on esophageal physiology and mucosal integrity that may be informative for determining disease severity. This includes characterization of esophageal peristalsis and esophago-gastric junction (EGJ) barrier function, based upon EGJ hiatus hernia subtype morphology and EGJ contractility. E-HRM may potentially have a role in the investigation of recurrent transit hold-up symptoms following anti-reflux surgery. Finally, E-HRM may detect and differentiate patterns consistent with rumination syndrome.