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Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

by Mark Fox et al.

High resolution manometry is widely accepted in the clinical practice and is now considered the “golden standard” to diagnose esophageal motor disorders.  The inter-observer agreement of this test was not yet validated, however. In this article Mark Fox and colleagues asked 18 pratictioners from 13 institutions to analyze individual water swallows and 36 practitioners from 28 institutions to assess 40 diagnostic studies. Consensus agreement was found in most of normal peristalsis and in achalasia, but not for cases of peristaltic dysmotility.  In clinical studies the agreement among the assessors was substantial for achalasia type I/II, but fair to moderate for any diagnosis. The Authors suggest that in clinical practice diagnostic performance should be based not only on pattern recognition of HRM images, but also on quantitative metrics of contractile and intrabolus pressures that provide an obiective diagnosis of esophageal motor abnormalities.

Giovanni Zaninotto,
Editor in Chief
Diseases of the Esophagus

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