Evaluation of esophageal motility using high-resolution manometry in patients referred to a tertiary gastroenterology clinic with dysphagia

Introduction and Aim: Dysphagia is defined as difficulty in swallowing solids or liquids due to structural lesions or neuromuscular abnormalities. High-resolution manometry (HRM) and the Chicago Classification v4.0, based on HRM parameters, are currently used for the evaluation of esophageal motility disorders related to neuromuscular dysfunction. The aim of our study was to evaluate dysphagic patients without structural pathology using HRM, to assess the concordance of HRM findings with endoscopy and barium esophagography, and to determine the distribution of motility disorders in our center. Patients and Method: All patients who underwent HRM for dysphagia between June 2022 and April 2025 were included. Sociodemographic characteristics, dysphagia type, relation to food consistency, accompanying symptoms, systemic diseases, history of fundoplication or motility disorder, and endoscopic and radiological findings were retrospectively obtained from patient files and the hospital automation system. Results: A total of 126 patients were included, 62% of whom were female, with a mean age of 53±15 years. The most common type of dysphagia was esophageal dysphagia (87%). HRM findings showed achalasia in 46 patients (37%), most frequently Type II achalasia (33%). Normal motility was observed in 34% and ineffective esophageal motility (IEM) in 25%. In the achalasia group, IRP, panesophageal pressurization, and failed swallows were significantly higher, while intact swallows were lower (p<0.001). LES resting pressure and relaxation percentage, although not included in the Chicago algorithm, were also significantly different (p<0.001). Typical achalasia findings were detected in 54% of endoscopies and 57% of barium swallow studies. Conclusion: Type II achalasia was the most frequent motility disorder in our cohort. While endoscopy and barium esophagography provided supportive findings, HRM showed superior diagnostic accuracy and discriminatory power, confirming its indispensable role in evaluating dysphagia without organic pathology.