Table 1.

Triaging Patients for Esophageal Physiologic Testing

	Clinical Qualifiers	Alternative
Emergent/urgent procedures
HRM in suspected achalasia	Significant dysphagia, weight loss, regurgitation	Endoscopy with intubation and FLIP Barium esophagography
HRM prior to achalasia management	Plans for urgent management (PD or myotomy)	Endoscopy with intubation and FLIP/botulinum toxin injection Barium esophagography
HRM prior to antireflux surgery	Large hiatus hernia, risk for aspiration, pulmonary disease requiring lung transplantation	Barium esophagography
Semiurgent procedures
Dysphagia with weight loss (transition to an urgent HRM procedure if nutrition is compromised over 2–4 wk)	Frequent/daily symptoms Impacting quality of life Negative endoscopy/barium	Empiric management with PPI, soft/liquid diet
Dysphagia without weight loss	Frequent/daily symptoms Impacting quality of life Negative endoscopy/barium	Empiric management with PPI, soft/liquid diet
Chest pain	Frequent/daily symptoms Impacting quality of life Negative endoscopy/barium	Empiric management with PPI, pain modulators
Elective procedures
HRM/reflux monitoring for reflux symptoms prior to antireflux surgery or with incomplete PPI response	Elective, can be postponed	Medical reflux management, pain modulators, lifestyle measures
HRM in behavioral symptoms/suspected supragastric belching/rumination	Elective, can be postponed	Remote cognitive and behavioral therapy, diaphragmatic breathing

FLIP, functional lumen imaging probe; HRM, high resolution manometry; PD, pneumatic dilation; PPI, proton pump inhibitor.