High-resolution manometry uses a catheter with 36 solid-state pressure sensors spaced 1 cm apart to measure esophageal motility. It provides 2D and 3D spatial-temporal plots of pressure data along the esophagus. Classic achalasia shows no peristalsis and impaired lower esophageal sphincter relaxation, while other primary motility disorders like jackhammer esophagus have high amplitude contractions over 180 mmHg with double peaks and prolonged contractions over 6 seconds. HRM allows diagnosis of different motility disorders based on patterns of peristalsis, LES relaxation, and contraction amplitudes.

1. High-Resolution Manometry Basic overview Attila Dubecz

3. Measurement - Conventional C H A N E L S

4. 2D – 3D

5. 3D spatio-temporal plot

6. 3D to 2D Contour plot

7. Measurment - HRM

8. Classic achalasia No peristalsis, impaired LES

9. Achalasia ?

10. LES Relaxation? Relaxation?

11. No Relaxation

12. Primary motility disorders high amplitude > 180Hgmm double peak normal normal increased >40 Hgmm Nutcracker prolonged > 6sec, high amplitude double peak normal normal + simultaneous > 30% increased >40 Hgmm DES > 60Hgmm contractions incomplete simultaneous hypertensive Vigorous achalasia high resting intraesophageal pressures incomplete simultaneous hypertensive Achalasia BODY LES RELAXATION PERISTALSIS LES PRESSURE MOTILITY DISORDER

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