This is the current release of the guideline.

This guideline updates a previous version: An American Gastroenterological Association medical position statement on the clinical use of esophageal manometry. American Gastroenterological Association. Gastroenterology 1994 Dec;107(6):1865.

According to the guideline developer, the Clinical Practice Committee meets three times a year to review all American Gastroenterological Association Institute (AGAI) guidelines. This review includes new literature searches of electronic databases followed by expert committee review of new evidence that has emerged since the original publication date.

Conditions for which esophageal manometry may be indicated, such as:

• Esophageal motility disorders (e.g. dysphagia or achalasia)
• Esophageal motor abnormalities
• Conditions requiring placement of intraluminal devices (e.g., pH probes)
• Conditions requiring antireflux surgery

Assessment of Therapeutic Effectiveness
Diagnosis
Evaluation
Management

Gastroenterology

Physicians

To assist physicians in the appropriate use of esophageal manometry in patient care

• Adults with esophageal syndromes, such as achalasia or dysphagia
• Adults being considered for antireflux surgery if uncertainty remains regarding the correct diagnosis.
• Adults requiring placement of intraluminal diagnostic devices

Esophageal manometry

• Utility of esophageal manometry in clinical practice
• Impact of manometry on management decisions in gastroesophageal reflux disease
• Prognostic value of manometric findings with regard to postoperative outcome in patients with esophageal motility disorders (i.e., control of reflux symptoms and incidence of symptomatic dysphagia)

Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

The guideline developers performed a literature search for all English-language articles dealing with manometric evaluation of the esophagus from 1994 to 2003. The databases searched included MEDLINE, PreMEDLINE, and PubMed using general terms related to manometric technique (sleeve, topography) and equipment (water perfused, solid state), esophageal symptoms (dysphagia, chest pain, heartburn), esophageal disorders and procedures (gastroesophageal reflux disease, achalasia, diffuse esophageal spasm, nutcracker esophagus, hypertensive lower esophageal sphincter [LES], nonspecific motor disorders, ineffective esophageal motility, fundoplication, myotomy, dilation), and terms focused on esophageal motor function (upper esophageal sphincter, lower esophageal sphincter, esophageal body, peristalsis). Additional references were identified from references of reviewed manuscripts.

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

The data used to formulate these recommendations are derived from the data available at the time of their creation. Ideally, the intent is to provide evidence based upon prospective, randomized, placebo-controlled trials; however, when this is not possible the use of experts' consensus may occur.

Not applicable

Guideline developers reviewed published cost analyses.

External Peer Review

The document was approved by the American Gastroenterological Association Clinical Practice Committee on October 2, 2004, and by the American Gastroenterological Association Governing Board on November 7, 2004.

These recommendations are an update from previous recommendations published in 1994 and represent the results of meticulous research into areas of controversy from the previous policy statement. In addition, new techniques have evolved that may improve and complement manometric diagnosis. Thus, these recommendations also take into account how these new technologies may alter clinical practice.

Indications for Esophageal Manometry

1. Manometry is indicated to establish the diagnosis of dysphagia in instances in which a mechanical obstruction (e.g., stricture) cannot be found. This is particularly important if a diagnosis of achalasia is suspected. However, given the low prevalence of achalasia in patients with esophageal symptoms, more common esophageal disorders should be excluded with barium radiographs or endoscopy before manometric evaluation.
2. Manometric techniques are indicated for placement of intraluminal devices (e.g., pH probes) when positioning is dependent on the relationship to functional landmarks, such as the lower esophageal sphincter.
3. Manometry is indicated for the preoperative assessment of patients being considered for antireflux surgery if there is any question of an alternative diagnosis, especially achalasia.

Possible Indications for Esophageal Manometry

1. Manometry is possibly indicated for the preoperative assessment of peristaltic function in patients being considered for antireflex surgery.
2. Manometry is possibly indicated to assess symptoms of dysphagia in patients who have undergone either antireflux surgery or treatment for achalasia.

Esophageal Manometry Not Indicated

1. Manometry is not indicated for making or confirming a suspected diagnosis of gastroesophageal reflux disease.
2. Manometry should not be routinely used as the initial test for chest pain or other esophageal symptoms because of the low specificity of the findings and the low likelihood of detecting a clinically significant motility disorder.

None provided

The type of evidence supporting the recommendations is not specifically stated.

The recommendations are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature.

Appropriate clinical use of esophageal manometry

Not stated

The Medical Position Statements (MPS), developed under the aegis of the American Gastroenterological Association (AGA) and its Clinical Practice Committee (CPC), were approved by the AGA Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized, placebo-controlled trials; however, when this is not possible the use of experts' consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient's current medical situation.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness

Not applicable: The guideline was not adapted from another source.

1994 Jul 15 (revised 2005 Jan)

American Gastroenterological Association Institute - Medical Specialty Society

American Gastroenterological Association Institute

American Gastroenterological Association Clinical Practice Committee

Authors: John E. Pandolfino; Peter J. Kahrilas

Not stated

This is the current release of the guideline.

This guideline updates a previous version: An American Gastroenterological Association medical position statement on the clinical use of esophageal manometry. American Gastroenterological Association. Gastroenterology 1994 Dec;107(6):1865.

According to the guideline developer, the Clinical Practice Committee meets three times a year to review all American Gastroenterological Association Institute (AGAI) guidelines. This review includes new literature searches of electronic databases followed by expert committee review of new evidence that has emerged since the original publication date.

None available

This summary was completed by ECRI on June 30, 1998. It was verified by the guideline developer on December 1, 1998. This NGC summary was updated by ECRI on January 31, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Public Policy Coordinator, American Gastroenterological Association, 4930 Del Ray Avenue, Bethesda, MD 20814; telephone, (301) 654-2055; fax, (301) 654-5970.