Table 2.

Strength of the GRADE recommendations for esophageal physiologic testing for obstructive symptoms

Statement	GRADE quality	Strength of recommendation
We suggest that patients with obstructive esophagealsymptoms without a mechanicalcause should undergo HRM for evaluation of esophageal motility disorders	Very low	Conditional
We recommend HRM over conventional line tracing manometry forthe diagnosis of esophagealmotility disorders in patients with obstructive esophagealsymptoms	Moderate	Strong
We suggest utilization of supplementary/provocative maneuvers with the HRM protocolto improve the diagnostic yield of esophagealmotility disorders in patients with obstructive esophagealsymptoms	Low	Conditional
We suggest the inclusion of a barium tablet with a barium esophagram during the evaluation of obstructive esophagealsymptoms	Very low	Conditional
We suggest the use of FLIP to complement HRM forthe diagnosis of esophagealmotility disorders in patients with obstructive esophageal symptoms and borderline HRM findings.	Low	Conditional
We suggest that the EGJ and gastric cardia anatomy should be inspected endoscopically and/or radiographically to assess for mechanical abnormalities in patients with esophagealsymptoms after antireflux surgery	Very low	Conditional

Please refer to the text for detailed discussion and evidence regarding each of the recommendations.

EGJ, esophagogastric junction; FLIP, functional lumen imaging probe; GRADE, Grading of Recommendations Assessment, Development and Evaluation; HRM, high-resolution manometry.