Pathophysiology of GERD : Ineffective Esophageal Motility

13 ESOPHAGEAL MOTILITY TESTING Occasionally endoscopy and barium esophagogram reports contain information about esophageal motility. Still, esophageal manometry is considered the gold standard in evaluating and quantifying esophageal motility. Esophageal manometry in patients with GERD is recommended to investigate the presence of esophageal motility abnormalities associated with GERD and to locate the lower esophageal sphincter (LES) for adequate placement of esophageal pH testing devices. The manometric systems can be classified into waterperfused and solid-state depending on the characteristics of the transducers used to measure pressure. Wa t e rp e rfused systems use a complex assembly of tubes inside a catheter and water pumps that transmit the intraesophageal pressure through water columns to external pressure sensors. In solid-state systems small pressure transducers are mounted on a catheter allowing direct measurement of intraesophageal pressure. Both systems provide information on intraesophageal pressures and peristaltic sequence of contractions during swallowing. During esophageal manometry the patient is traditionally in a recumbent position and is given a predefined amount of liquids. The supine position may be considered non-physiologic for swallowing but it has the advantage of eliminating the influence of gravity on bolus movement, thus providing the “maximum” challenge to the esophageal musculature. The supine position is also required by water-perfused systems for a proper alignment of the external transducers to the esophagus, a shortcoming eliminated when using solid-state systems. Pathophysiology of GERD: Ineffective Esophageal Motility GERD IN THE 21st CENTURY, SERIES #6