Normal values for solid‐state esophageal high‐resolution manometry in a European population; an overview of all current metrics

• Published in: Neurogastroenterology and motility Vol. 26; no. 5; pp. 654 - 659
• Main Authors: Weijenborg, P. W., Kessing, B. F., Smout, A. J. P. M., Bredenoord, A. J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2014
• Subjects: Adolescent; Adult; esophageal motility; Esophageal Sphincter, Upper - physiology; Esophagogastric Junction - physiology; esophagus; Esophagus - physiology; Europe; Female; high‐resolution manometry; Humans; Male; Manometry - methods; Middle Aged; normal values; Peristalsis - physiology; Reference Values; Young Adult; Europe; normal values; high-resolution manometry; esophageal motility; esophagus
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.12314

Background Esophageal high‐resolution manometry (HRM) allows accurate evaluation of esophageal motility. Normal values for HRM were established in the United States and several new parameters were introduced since. We aimed to provide a complete set of normal values for HRM obtained in a European population, including all current metrics used to describe the function of the upper esophageal sphincter (UES), the esophageal body, and the esophagogastric junction (EGJ). Methods Fifty healthy volunteers underwent esophageal HRM. Subjects swallowed 10 liquid boluses in supine position, after which UES, EGJ, and contraction wave parameters were evaluated. Mean and median values with 5–95th percentile ranges were calculated. Key Results The normative thresholds (5–95th percentile) for the various parameters were; UES resting pressure 34.6–137.7 mmHg, UES residual pressure 0.0–8.5 mmHg, UES 0.2‐s integrated relaxation pressure (IRP) 0.0–14.5 mmHg, EGJ length 3.1–6.3 cm, EGJ resting pressure 3.0–31.2 mmHg, EGJ 4‐s IRP 2.0–15.5 mmHg, intrabolus pressure (IBP) 6.6–19.5 mmHg, distal contractile integral 178–2828 mmHg*s*cm, contractile front velocity (CFV) 2.9–5.9 cm s−1, distal latency 5.4–8.5 s, and transition zone length 0.0–8.2 cm. Conclusions & Inferences Most HRM parameters assessed in this study resemble the previously described values on which the current criteria are based, supporting the widespread use of these criteria for clinical purposes. However, vigor of the esophageal contraction was lower and transition zone length larger than in previous reports. Peristaltic breaks occur frequently in healthy subjects. This study describes an additional set of normal values for all currently used esophageal HRM parameters, obtained in a population of 50 asymptomatic European subjects. Differences with previously published data were found for the distal contractile integral (DCI) and for the length of the transition zone. Current normal values for DCI and pressure breaks in the Chicago classification may need to be reconsidered.