Esophageal Motility Testing PDF

PREFACE

The history of esophageal manometry relates closely to technologic breakthroughs. The early balloon and kymograph techniques were replaced by transducers and waterfilled open tubes. The introduction of a capillary infusion system increased the accuracy of the measurements. Data collection and analysis were still tedious and esophageal investigation was largely limited to interested research teams. Computer analysis revolutionized data collection, opening the techniques to clinical investigations. The rapidly expanding usage and the competitive response of the industry in the manufacture of several systems demonstrated the need.The introduction of ambulatory pH and motility recorders further increased diagnostic accuracy and enabled gastroenterologists to characterize motility disorders and to evaluate gastroesophageal reflux, chest pain, and extraesophageal manifestations of reflux.

Recently laparoscopic surgery and laparoscopic antireflux techniques have become more popular, and large reported series have attested to the safety and efficacy of these procedures. Careful manometric evaluation of the esophagus and its sphincters prior to surgery has guided the surgeon in the choice of the procedure best matched to esophageal function. Many surgeons now attend courses in manometry and include these tests in their own clinics. Gastroenterologists have made tremendous strides in the last 10 years in elucidating the causes of esophageal symptoms and have further refmed the indications for motility testing.

This atlas describes the patterns of named motility disorders of the esophagus and their evaluation using both stationary and ambulatory techniques.The use ofpH and bilirubin probes is included because these are frequently used in conjunction with motility recordings. A further section describes unusual patterns that the authors have found to be important in clinical practice.

The following colleagues have contributed to the esophageal studies and collection of data for the motorized pull-through, lower sphincter relaxation, and bolus pressure studies: David Bowery, M.D., Guilherme Campos, M.D., Majid Hashemi, M.D., Hamrah Pedram, M.D., Jorg Theisen, M.D., Jan Johansson, M.D., Reginald Lord, M.D., and Abraham Nisim.

Thanks to Pat Sanchez for typing and coordinating the manuscript.