Color Atlas of High Resolution Manometry

While reflux disease, achalasia, esophageal spasm, gastroparesis and IBS include some of the most common disorders in all disease categories, the understanding of their pathophysiology has remained elusive. The field of clinical gastrointestinal motility has for decades relied on the measurement of intestinal movements for diagnosis and management of these difficult and enigmatic disorders of gut function. Although computers have increased the speed with which we can measure the movements of the gut, the devices to measure this movement have not changed in over 20 years. In the last 2 years, a new technologic breakthrough has taken place in the measurement of intestinal movement. The technology is called high resolution manometry. Rather than the old 4 and 8 channels systems of measuring pressure, high resolution employs 36 closely spaced solid state pressure transducers. By using this technology, the resolution of gut motor activity is incredible. This allows for better ways of viewing motility using color as pressure. This technology makes for beautiful images of gut motility that we have never seen before. We have made diagnoses that would never have been appreciated with the old technology. High resolution manometry is taking over conventional manometry worldwide and represents a dramatic leap in a long time stagnant area.

While reflux disease, achalasia, esophageal spasm, gastroparesis and IBS include some of the most common disorders in all disease categories, our understanding of their pathophysiology remains elusive. The field of clinical gastrointestinal motility has for decades relied on the measurement of intraluminal pressures to deduce intestinal movements that define these difficult and enigmatic disorders of gut function. Although computers have greatly facilitated the analysis of data obtained from intraluminal pressure recordings, the sensors and catheters used to measure intraluminal pressures have changed little over the last 20 years.

In the last 3 years, a new technologic breakthrough has taken place in the evaluation of gastrointestinal motor function. It is called high-resolution manometry. Rather than the old 4 to 8 channel conventional systems used to measure intraluminal pressure, high-resolution catheters employ 36 closely spaced, solid state pressure transducers. This technology enhances the resolution of gut motor activity incredibly. By using color to depict pressure, high-resolution color contours are beautiful images that give a detailed spatial and temporal picture of gastrointestinal motor function that was previously impossible. By recognizing motor patterns, diagnoses can be made that are very difficult, if not impossible, to appreciate with the old technology. High-resolution manometry is a dramatic technical leap in a long time stagnant field.

Jeffrey Conklin, MD, is Medical Director, Esophageal Center at Cedars-Sinai Medical Center, Los Angeles, California.

Mark Pimentel, MD, is Director, GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, California.

Edy Soffer, MD, is Co-Director, GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, California.