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Esophageal Pressure Mapping
Chicago Classification v4.0
High-Definition Pressure Topography

Esophageal manometry maps the muscular mechanics of swallowing in real time, capturing coordinated pressure events that imaging, endoscopy, and breath testing cannot see.

Method
High-resolution pressure-sensing catheter
Duration
45–60 minutes
Region studied
Esophagus, including the lower esophageal sphincter (LES)
Classification
Chicago Classification v4.0

A catheter lined with closely spaced pressure sensors generates a continuous, spatially resolved picture of pressure activity as you swallow. The result shows not just whether the esophagus is contracting, but where, in what sequence, with what force, and whether the lower esophageal sphincter relaxes appropriately with each swallow.

What esophageal manometry identifies
Disorder
Presentation
Achalasia (Types I–III)
Impaired LES relaxation, absent peristalsis. Progressive dysphagia, regurgitation, chest discomfort.
EGJ Outflow Obstruction
Elevated LES pressure with incomplete relaxation. Overlaps clinically with achalasia; distinguished by pattern.
Hypercontractile Esophagus
Markedly elevated contraction force. Chest pain and dysphagia that may mimic cardiac symptoms.
Ineffective Peristalsis
Failed coordinated contraction. Associated with reflux, regurgitation, slow esophageal clearance.

Manometry is frequently ordered alongside a broader reflux evaluation, since impaired esophageal clearance is a common contributor to reflux that medication alone doesn't resolve. See our GERD and reflux evaluation for how the two connect.

Commonly Ordered For

Patients with persistent dysphagia, unexplained chest discomfort, or reflux unresponsive to standard therapy, particularly where an upper endoscopy has already come back normal.

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