British Society of Gastroenterology Guidelines for Oesophageal Manometry and Oesophageal Reflux Monitoring

Gut

Trudgill, N. J., Sifrim, D., et al. (2019).

Gut, 68(10), 1731-1750.

This is an updated guideline from the British Society of Gatroenterology providing recommendations on oesophageal manometry, oesophageal pH monitoring, and oesophageal impedance monitoring for adults with dysphagia disorders. This summary highlights recommendations within the scope of speech-language pathology.

British Society of Gastroenterology

"Patients with dysphagia should preferably have an endoscopy with oesophageal biopsies to rule out and treat mucosal and structural disorders prior to manometry. Barium swallow should be considered where endoscopy is not possible and/or where structural disorders require further scrutiny" (Moderate-quality Evidence, Strong Recommendation; p. 1737).

For adults undergoing evaluation for dysphagia, recommendations for manometry include:<ul> <li>"High resolution manometry (HRM) is superior to standard manometry in terms of reproducibility, speed of performance and ease of interpretation" (High-quality Evidence, Strong Recommendation; p. 1735).</li> <li>"The addition of impedance to HRM can be a helpful adjunct to 'visualise' bolus movement and peristalsis effectiveness; however, its utility in clinical practice and impact on therapeutic decision making is not yet clear" (Moderate-quality Evidence, Conditional/Weak Recommendation; p. 1736).</li> <li>"Adjunctive testing (e.g., larger volumes of water, solid/viscous swallows or a test meal) can provide additional information and unmask pathology not seen with standard water swallows, as they are more representative of normal swallowing behaviour and more likely to induce symptoms and, in turn, improve diagnostic yield" (High-quality Evidence, Strong Recommendation; p. 1736).</li> <li>"Among patients with major motility disorders other than achalasia (diffuse oesophageal spasm, hypercontractile oesophagus, absent peristalsis), HRM, compared with standard manometry, may provide increased diagnostic and functional information changing intervention" (Moderate-quality Evidence, Conditional/Weak Recommendation; p. 1738).</li></ul>