Table 2. Recommended toolkit for step-by-step interpretation of esophageal high-resolution manometry.

Toolkit for the Clinical Interpretation of Esophageal High Resolution Manometry
First Steps	□Thermally compensate the study, if required □Assess for technical adequacy and presence of artifact
Baseline Phase	□Position baseline landmarks – UES, proximal and distal LES borders with electronic sleeve, gastric markers □Identify the pressure inversion point (PIP) □Examine EGJ morphology
Individual Swallow	□Measure the IRP, reposition landmarks if needed □Identify the CDP, and measure the DCI & and DL □Measure spatial breaks when present under an isobaric contour of 20mmHg □Assess for pressurization under an isobaric contour of 30mmHg
Synthesize the Information	□Calculate the median IRP □Calculate the proportion of swallows with: ▪failed, weak, normal, or hypercontractile vigor ▪premature or normal latency interval* ▪fragmented peristalsis* ▪panesophageal pressurization □Apply these calculations towards the Chicago Classification v3.0
Documentation	Include the following information in an esophageal manometry procedure report □Reason for referral/Indication □Final motility diagnosis accompanied by classification scheme used for interpretation □Summary of results □Tabulated results including UES activity, EGJ relaxation (typically in form of IRP), presence or absence of PIP, contractile function, peristaltic integrity, and pressurization pattern □Technical limitations, if any □Communication to referring provider
Optional Applications	□Assess the baseline phase and each swallow in the seated position □Interpret response to provocative measures (viscous/solid swallow, multiple rapid swallow, rapid water bolus) □Add the impedance function when available to assess bolus transit and, if performed, post-prandial responses □Assess the EGJ Contractile Integral

Integrated relaxation pressure (IRP); Esophagogastric junction (EGJ); Upper esophageal sphincter (UES); Crural diaphragm (CD); Lower esophageal sphincter (LES); Contractile deceleration point (CDP); Distal contractile integral (DCI); Distal latency (DL).