• 1 Division of Gastroenterology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2 Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
  • 3 Division of General, Mininvasive and Bariatric Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
  • 4 Upper GI Physiology Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom
  • 5 Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, CIBERehd, Badalona, Spain
  • 6 Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
  • 7 Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France; Digestive Physiology, Université de Lyon, Lyon, France; LabTAU, INSERM U1032, Université de Lyon, Lyon, France
  • 8 Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, México
  • 9 Department of Gastroenterology, British Hospital and El Cruce Hospital, Buenos Aires, Argentina
  • 10 Unidad de Motilidad, Servicio de Aparto Digestivo, Hospital Clínico San Carlos, Madrid, Spain
  • 11 Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
  • 12 Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
  • 13 Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia; School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
  • 14 Department of Gastroenterology, Kamimoku SPA Hospital, Minakami, Japan
  • 15 Motility Lab, Department of Gastroenterology, St. George's Hospital, London, United Kingdom
  • 16 Center of Excellence on Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 17 Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago de Chile, Chile; Department of Gastroenterology, St George's University Hospitals NHS Trust, London, United Kingdom
  • 18 Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 19 Upper GI Physiology Unit, Department of Gastroenterology, Ege University, Izmir, Turkey
  • 20 Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai, India
  • 21 Department of Gastroenterology, University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil
  • 22 Division of Gastroenterology, Washington University School of Medicine in St Louis, St Louis, Missouri. Electronic address:
Clin Gastroenterol Hepatol, 2022 Mar;20(3):e398-e406.
PMID: 33144149 DOI: 10.1016/j.cgh.2020.10.052


OBJECTIVE: High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.

DESIGN: Manometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders.

RESULTS: Of 469 unique HRM studies (median age 28.0, range 18-79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%-8.5%). Other motor patterns were rare (0.2%-4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions.

CONCLUSIONS: Motor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.