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The Clinical Utility of Provocative Maneuvers at Esophageal High-resolution Manometry (HRM).

Esophageal high-resolution manometry (HRM) assesses esophageal motor function and is indicated both for evaluation of esophageal symptoms and before antireflux interventions. HRM studies are interpreted and esophageal motor diagnoses made according to the Chicago Classification, version 3.0 algorith...

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Published in:Journal of Clinical Gastroenterology Vol. 55; no. 2; pp. 95 - 103
Main Authors: Horton, Anthony, Jawitz, Nicole, Patel, Amit
Format: Journal Article
Published: Lippincott Williams & Wilkins Feb2021
Online Access:View this record in EBSCOhost
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      jtl: Journal of Clinical Gastroenterology
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      dt: Feb2021
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      pub: Lippincott Williams & Wilkins
      place: Baltimore, Maryland
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        atl: The Clinical Utility of Provocative Maneuvers at Esophageal High-resolution Manometry (HRM).
      aug:
        au:
          Horton, Anthony
          Jawitz, Nicole
          Patel, Amit
        affil: Division of Gastroenterology, Duke University School of Medicine
      sug:
        subj:
          Esophageal Motility Disorders Diagnosis
          Deglutition
          Manometry
          Illinois
          Scales
      ab: Esophageal high-resolution manometry (HRM) assesses esophageal motor function and is indicated both for evaluation of esophageal symptoms and before antireflux interventions. HRM studies are interpreted and esophageal motor diagnoses made according to the Chicago Classification, version 3.0 algorithm, which is based on ten 5 mL supine water swallows. However, this practice of single liquid swallows performed in the supine position does not reflect typical "real-life" swallowing, and may not reproduce the patient's presenting symptoms. Therefore, provocative maneuvers at HRM-beyond these 10 standard swallows-can afford additional insights into esophageal motor function with clinically significant implications, and represent areas of exciting investigation and innovation. Accordingly, the 2020 American College of Gastroenterology Guidelines on Esophageal Physiologic Testing conditionally recommend their inclusion in the HRM protocol. In this clinical review, we discuss the supporting data for and clinical utility of provocative maneuvers at HRM that include changes in body position or accessories (upright swallows, "bridge" position, straight leg raise, abdominal compression), bolus consistency (solid swallows, test meals, postprandial high-resolution impedance manometry), bolus frequency (multiple rapid swallows), the volume of bolus (rapid drink challenge/multiple water swallows), and the use of pharmacological agents.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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