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## Complete Summary

#### GUIDELINE TITLE

American Gastroenterological Association medical position statement:
clinical use of esophageal manometry.

#### BIBLIOGRAPHIC SOURCE(S)

Pandolfino JE, Kahrilas PJ. American Gastroenterological Association
medical position statement: clinical use of esophageal manometry.
Gastroenterology 2005 Jan;128(1):207-8.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15633137)

#### GUIDELINE STATUS

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.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

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

#### GUIDELINE CATEGORY

Assessment of Therapeutic Effectiveness\
Diagnosis\
Evaluation\
Management

#### CLINICAL SPECIALTY

Gastroenterology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

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

#### TARGET POPULATION

-   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

#### INTERVENTIONS AND PRACTICES CONSIDERED

Esophageal manometry

#### MAJOR OUTCOMES CONSIDERED

-   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)

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

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

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

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.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

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.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

Guideline developers reviewed published cost analyses.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

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.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

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.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

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.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate clinical use of esophageal manometry

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Pandolfino JE, Kahrilas PJ. American Gastroenterological Association
medical position statement: clinical use of esophageal manometry.
Gastroenterology 2005 Jan;128(1):207-8.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15633137)

#### ADAPTATION

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

#### DATE RELEASED

1994 Jul 15 (revised 2005 Jan)

#### GUIDELINE DEVELOPER(S)

American Gastroenterological Association Institute - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

American Gastroenterological Association Institute

#### GUIDELINE COMMITTEE

American Gastroenterological Association Clinical Practice Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Authors*: John E. Pandolfino; Peter J. Kahrilas

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

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.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Gastroenterological
Association Institute (AGAI) Web
site](http://www.gastrojournal.org/article/PIIS0016508504020037/fulltext).

Print copies: Available from American Gastroenterological Association
Institute, 4930 Del Ray Avenue, Bethesda, MD 20814.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   American Gastroenterological Association technical review on the
    clinical use of esophageal manometry. Gastroenterology 2005
    Jan;128(1);209-24.

Electronic copies: Available from the [American Gastroenterological
Association Institute (AGAI) Web
site](http://www.gastrojournal.org/article/PIIS0016508504020049/fulltext).

Print copies: Available from American Gastroenterological Association
Institute, 4930 Del Ray Avenue, Bethesda, MD 20814.

#### PATIENT RESOURCES

None available

#### NGC STATUS

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.

#### COPYRIGHT STATEMENT

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.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008