Manometry & pH-monitoring

Currently esophageal manometry categorizes (Fig. 3):

  1. Total- and abdominal length of the lower esophageal sphincter (LES)
  2. Resting and residual pressure distal or at the so called respiratory inversion point (RIP; transition from positive abdominal to negative intra-thoracic pressure). It is assumed that pressure at the RIP is representative for the whole LES length.
  3. esophageal body motility.

Currently esophageal manometry does not consider:

  1. Low pressure zone within the distal part of the LES,
  2. that this low pressure zone may be a playground for GERD (morphology, symptoms). Proximal to this low pressure zone frequently exists a normal pressure zone, impairing reflux above the LES.
  3. that this low pressure zone is indicative for ?dilated end stage esophagus? (see novel concept).

Drawback: early LES changes limited to the distal part of the LES are missed (pressure profile associated with 'dilated end stage esophagus').

Figure 3: esophageal manometry according to the current concept.

Currently pH monitoring (±impedance) with pH probe placement 5 cm above the LES misses (see Fig. 4):

  1. intra LES acid exposure
  2. acid exposure < 5 cm above the LES

Drawback: individuals with early GERD limited to the distal part of the LES (=dilated end stage esophagus) are missed and categorized as functional heartburn or NERD.

Figure 4: pH monitoring according to the current concept.