Introduction Oesophageal physiology testing has advanced markedly in the last decade. Tools such as high resolution manometry (HRM) have become widely available and have enhanced our understanding of oesophageal (dys)function. However this has also led to wide variation in testing methods and analysis. Before a consensus is built towards setting quality standards in physiological measurement, a better understanding of what procedures and practices actually take place globally is required.
Method An on-line survey was distributed to oesophageal laboratories through NGM societies around the world using the internet-based Qualtrics platform. Questions explored infrastructure, staffing, technology, analysis and reporting. Labs responded anonymously. Responses from all labs were then compared.
Results To date 41 responses have been received. Of the 17 in Britain/Ireland, 8 see 500–1000 referrals/year (3 >1000) while 9 see <500 cases/year. Both high volume (HV) and low volume (LV) centres employ a median of 7 members of staff; median 2.5 clinicians in HV and 1.0 in LV centres (p = 0.08). In comparison, of the 9 centres in USA, 6 in Europe and 9 in Australia, the overall median number of staff are 9, 7.5 and 5, of whom 4, 2 and 2 are clinicians respectively.
In the Britain/Ireland, 7/17 centres use water-perfused and 10/17 use solid-state systems. 14 are high resolution of which 11 consist of at least 26 sensor systems (4 also with Impedance). In contrast, all labs in the USA and in Europe include a solid-state HRM systems with >26 sensors and with Impedance, while in Australia 8/9 labs have >26 sensor HRM systems, 5 of which include Impedance.
Upright studies are routinely included in 5 centres in Britain/Ireland, 4 in USA, 3 in Europe and 4 in Australia. Details regarding adjunctive testing are presented in Table 1. In the UK, one HV and 2 LV centres never use the Chicago Classification (CC) to reach a diagnosis unlike all centres in Ireland, USA, Europe and Australia. Across all centres, placement of the lower oesophageal sphincter and gastric markers varies widely with varying sizes of hiatus hernia.
Information provided in the final HRM report is fairly uniform apart from ‘therapeutic recommendations’ which is included in 4/17 centres in Britain/Ireland (3/8 HV and 1/9 LV centres), 3/9 in USA, 5/6 in Europe and 4/9 in Australia.
Conclusion There is marked heterogeneity in the methodology, analysis and presentation of HRM studies in oesophageal laboratories around the world. This (ongoing) study sets the stage upon which mechanisms to improve quality and uniformity in testing and reporting can be agreed upon internationally.
Disclosure of interest R. Sweis Grant/ Research Support from: Grant from Reckitt Benkiser, Conflict with: Invited as speaker for Given Imaging, M. Fox Consultant for: Member of advisory board and research/education funds from Given Imaging/Covidien, MMS and Sandhill.
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