Combined impedance-manometry for the evaluation of esophageal disorders

Purpose of review Combined impedance-manometry was introduced just over 20 years ago for the assessment of esophageal motor function. Since then, technical developments have led to the introduction of high-resolution impedance-manometry (HRIM). However, analysis of the impedance and manometry recordings has remained separate and relatively unchanged since the introduction of HRIM, and it is unclear whether the addition of impedance has had a significant impact on the management of esophageal motor disorders. Recent findings The major technical advance over the past 12 months or so has been the development of automated impedance-manometry (AIM) analysis, in which the impedance and manometric data are analyzed together to assess the interactions between pressure and flow. This analysis has revealed subtle abnormalities in esophageal function in patients with nonobstructive dysphagia who have normal manometry and conventional impedance analyses. AIM analysis has also revealed preoperative characteristics in patients that may predict the occurrence of postfundoplication dysphagia. Summary Through ongoing technical development, impedance-manometry is becoming increasingly useful clinically to assess esophageal motility disorders as well as to provide further insights into esophageal physiology.