High-Resolution Manometry in Esophageal Motility Disorders: Latest Clinical Evidence and the Impact of Chicago Classification Version 4.0
Keywords:
High-resolution manometry, Chicago Classification 4.0, esophageal motility disorders, achalasia, EGJ outflow obstruction, provocative maneuvers, functional lumen imaging probeAbstract
High-resolution manometry (HRM) has fundamentally transformed the diagnosis and management of esophageal motility disorders (EMDs) by providing detailed, spatiotemporal pressure topography and offers a superior evaluation of esophageal function compared to conventional ‘manometry. HRM interpretation is standardized by the Chicago Classification (CC). The clinical landscape has evolved significantly with the introduction of CC version 4.0 (CCv4.0) and complementary technologies. This review article provides an updated synthesis of HRM in clinical practice, incorporating the latest evidence. It discusses key changes introduced in CCv4.0, such as the expanded protocol with provocative maneuvers (Multiple Rapid Swallows and Rapid Drink Challenge) and a refined diagnostic framework for achalasia, esophagogastric junction outflow obstruction (EGJOO), and peristaltic abnormalities. The article also explores the critical pre-operative role of HRM before anti-reflux surgery and its utility in evaluating refractory GERD symptoms. Furthermore, it addresses the growing importance of combining HRM with adjunct technologies like FLIP, barium radiography to enhance diagnostic confidence, especially in challenging cases. Finally, the review outlines current limitations, such as symptom correlation for minor disorders, and discusses future perspectives in the field.
