How to Read and Report Esophageal Manometry Studies

Esophageal manometry measures pressure and coordination throughout the oesophagus and at the oesophagogastric junction (EGJ). High-resolution manometry (HRM) has become central to assessing dysphagia, regurgitation, chest pain and suspected achalasia when endoscopy and imaging do not fully explain symptoms.

A useful report does more than attach a diagnostic label. It shows whether the study was technically reliable, describes the key pressure findings, applies an accepted classification system and explains how the results fit the clinical picture. This approach supports consistent communication between gastroenterologists, surgeons, speech pathologists and referring doctors across Australia.

Confirm the study quality

Begin by recording the catheter position, the duration of the study and whether the lower oesophageal sphincter (LES) and upper oesophageal sphincter were captured clearly. The tracing should include baseline observations and a standard series of supine and, where appropriate, upright water swallows. Note coughing, retching, belching, poor co-operation or catheter movement, as these can distort pressure measurements.

The protocol may include multiple rapid swallows, a rapid drink challenge or solid swallows when clinically indicated. These manoeuvres provide information about contractile reserve and outflow obstruction but should not replace the standard sequence. If fewer than the required swallows are analysable, state this plainly rather than presenting a confident classification based on limited data.

Read the main metrics

The integrated relaxation pressure (IRP) estimates EGJ relaxation during swallowing. Its interpretation depends on the catheter system, body position and laboratory reference range. A raised IRP suggests impaired EGJ relaxation, but it does not by itself prove achalasia. Opioid use, hiatal hernia, catheter artefact and positioning can produce misleading values.

Assess contractile strength using the distal contractile integral (DCI), and assess timing with distal latency. Record whether contractions are intact, weak, failed, premature or rapidly propagated. Also look for panesophageal pressurisation, repetitive contractions and excessive distal contractility. The report should distinguish an abnormal single swallow from a repeated pattern that meets diagnostic criteria.

Apply a recognised classification

The Chicago Classification, currently used with HRM, provides a structured framework for diagnosis. Achalasia type I is characterised by impaired EGJ relaxation with absent contractility. Type II includes panesophageal pressurisation, while type III involves premature or spastic contractions. These categories matter because they influence discussions about pneumatic dilation, laparoscopic myotomy, peroral endoscopic myotomy and other treatments.

Other patterns include EGJ outflow obstruction, absent contractility, distal oesophageal spasm, hypercontractile oesophagus and ineffective oesophageal motility. A borderline result should be described as such. For example, suspected EGJ outflow obstruction may require supportive evidence from timed barium oesophagram, endoflip assessment or repeat testing in a suitable clinical setting.

Build a clinically useful report

A clear report usually starts with the indication and relevant medicines, particularly opioids, which may affect motility. It then documents the technical conditions, summarises EGJ morphology and relaxation, describes oesophageal body contractions, and comments on provocative tests. If a hiatal hernia or abnormal pressurisation is present, include it in the body of the report rather than leaving it implicit.

The impression should be concise but qualified. State the manometric diagnosis, the strength of the evidence and any limitations. “Findings are consistent with type II achalasia” is more useful than simply writing “abnormal motility.” Correlate the result with endoscopy, biopsies and imaging; manometry cannot determine whether dysphagia is caused by reflux injury, malignancy or a mechanical narrowing.

Communicate safely in Australian practice

In Australia, a patient referred from a public hospital in Sydney, a private clinic in Melbourne or a regional service near Brisbane may have tests performed on different systems and under different local protocols. Include the equipment, software or reference framework used, because numerical thresholds are not universally interchangeable. A report that identifies the laboratory method is easier to interpret when patients move between metropolitan and regional care.

Patient information must be handled under applicable privacy obligations, including the federal Privacy Act 1988 and, where relevant, state requirements such as Victoria’s Health Records Act 2001. Use secure clinical systems, verify identity and document consent for recording or sharing traces. For clinicians reviewing educational material from the World Congress for Esophageal Diseases, the ISDE 2021 website retains useful historical context and registration details.

Everyday factors can also matter. Australians commonly present after adapting meals around work, school or long commutes, and a history of avoiding meat, bread or large evening meals may help explain symptom severity without changing the manometric diagnosis. Ask about reflux treatment, cannabis or opioid use and the timing of symptoms, while avoiding assumptions based on diet or lifestyle.

A strong oesophageal manometry report is reproducible, transparent and clinically grounded. It identifies technical limitations, interprets pressure data using an accepted framework and avoids overstating what the test can prove. The key point to remember is that numbers become meaningful only when study quality, classification criteria and the patient’s wider clinical evidence are considered together.