• MALAVAN HABEEB MOHAMMED Asst. Professor, Department of Internal Medicine, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq.
Keywords: Achalasia, Dysphagia, Chicago, Esophageal Manometry classification, Esophageal motility disorder, High-Resolutio



Background: Advances in high-resolution esophageal manometry (HREM) have overturned the clinical assessment of esophageal motility disorders. It has been widely incorporated into clinical practice as it is a delicate diagnostic tool for assessing esophageal motility patterns. 

Objective: To assess the diagnostic ability of HRM in categorization of esophageal motility disorder using the Chicago Classification v3.0

Patients and Methods: a retrospective descriptive study done on 100 adult patients who underwent esophageal manometry test in the Endoscopy unit of Gastroenterology and Hepatology center at Azadi Teaching Hospital in Duhok city. The study was conducted from January 2021 to March 2022 by reviewing the high-resolution esophageal manometry of these patients using the Chicago classification v3.0. The recorded esophageal symptoms were correlated with the findings obtained during HREM test.

Results: The mean age of the participants was 44.8 years with a standard deviation of 16 year. Females were on average older than males with a mean age of 47.8 years compared to 41.2 year for males. More than half of the patients (53%) had dysphagia as the main symptom that HRM done for. Globus sensation was the second one (14%) followed by Gastroesophageal reflux disease (GERD) (13%). The yield of HRM found to be abnormal (77%) as esophageal motility disorders. Those patients with dysphagia had achalasia II as the highest frequency (28.3%), while no even one patient of those with GERD, globus sensation or nausea and vomiting had achalasia detected by HRM. The most frequent result of GERD patients was esophagogastric junction outflow obstruction (38.5%). More than half (57.1%) of patients with globus sensation had a normal HRM test. Distal esophageal spasm was found to be the most frequent finding among patient with non-cardiac chest pain.

Conclusion: There is an apparent diagnostic value of HRM in categorization of esophageal dysmotility when applying the Chicago Classification v3.0 in those patients with suggestive symptoms of motility disorders.


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1. Massey BT. Esophageal Motor and Sensory Disorders: Presentation, Evaluation & Treatment. Gastroenterol Clin N Am 2007; 36: 553–575.
2. Chicago Classification of Esophageal Motility Disorders: Lessons Learned W. O. A. Rohof1 & A. J. Bredenoord, Curr Gastroenterol Rep (2017) 19: 37
3. Fox MR, Pandolfino JE, Sweis R, Sauter M, Abreu YAAT, Anggiansah A, et al. Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in highresolution manometry. Dis Esophagus. 2015; 28(8):711–9
4. Gyawali CP, Patel A. Esophageal motor function: technical aspects of manometry. Gastrointest Endosc Clin N Am. 2014; 24:527–43.
5. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015; 27(2): 160–74.
6. Grübel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008; 6:525–530
7. Rena Yadlapati, MD, High-Resolution Esophageal Manometry: Interpretation in Clinical Practice. Curr Opin Gastroenterol. 2017; 33(4): 301–309.
8. Wang A, Pleskow DK, Banerjee S, Barth BA, Bhat YM, Desilets DJ, et al. Esophageal function testing. Gastrointest Endosc 2012; 76 (2): 231-243.
9. Douglas G. Adler, Yvonne Romero. Primary Esophageal Motility Disorders. Mayo Clinic Proceedings. 2001;76(2):195-200.
10. Patel, D. A., Lappas, B. M., & Vaezi, M. F. An Overview of Achalasia and Its Subtypes. Gastroenterology & Hepatology. 2017;13(7), 411-421.
11. van Hoeij FB, Bredenoord AJ. Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders. J Neurogastroenterol Motil. 2016; 22(1): 6-13
12. Pandolfino JE, Fox MR, Bredenoord AJ, Kahrilas PJ. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol Motil 2009; 21: 796-806
13. Jandee S, Jandee K. Diagnostic Yield of High-resolution Esophageal Manometry With Chicago Classification Version 3.0 in Thai Patients. J Neurogastroenterol Motil. 2021 Oct 30; 27(4): 533-539.
14. Gina Gamal Naguib, Mohamed Hassan, Ahmed I. Elshafie & M. G. Naguib, Esophageal motility abnormalities in Egyptian patients using high resolution esophageal manometry: a descriptive study; The Egyptian Journal of Internal Medicine. 2022; 34(1)
15. Roman S, Huot L, Zerbib F, Bruley des Varannes S, Gourcerol G,Coffin B, et al. High-resolution manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia: a randomized multicenter study. Am J Gastroenterol. 2016; 111(3): 372– 80.
16. Spechler, S. J. (2022, September). UpToDate. Retrieved October 28, 2022, from https://www.uptodate.com/contents/achalasia-pathogenesis-clinical-manifestations-and-diagnosis
17. Rohof WOA, Bredenoord AJ. Chicago Classification of Esophageal Motility Disorders: Lessons Learned. Curr Gastroenterol Rep. 2017; 19(8): 37.
18. Van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015; 27(9): 1310–6.
19. Mohammed MO, Salim BF, Ramadhan AA. Esophageal manometry among patients with dysphagia referred to Kurdistan center for gastroenterology and hepatology. Advanced Medical Journal. 2015; 1(1): 34-42.
How to Cite
HABEEB MOHAMMED, M. (2024). DIAGNOSTIC YIELD OF HIGH-RESOLUTION MANOMETRY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS. Duhok Medical Journal, 18(1), 66-76. Retrieved from https://dmj.uod.ac/index.php/dmj/article/view/301