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Introductory message from the President of the American Motility Society: intraluminal pressure measurement in the GI tract – when to use it and what to expect

In this present issue of Neurogastroenterology and Motility, Camilleri et al. review the indications, methods and clinical utility of intraluminal pressure measurements in the gastrointestinal (GI) tract. In the online version of this manuscript, the authors also address in an appendix, the procedure coding of these tests that pertain to the United States. This timely review, which represents the consensus views of the American Neurogastroenterology and Motility Society, puts in perspective these tests that are generally performed in GI motility laboratories by neurogastroenterologists and also by many adult and paediatric gastroenterologists in the community. The review succinctly summarizes when the test might be used, the information obtained, and when additional tests are required to provide a definitive diagnosis. Antroduodojejunal manometry has been available for clinical investigation for several decades, and is used in GI motility laboratories for evaluation of selected patients. This test is performed when the patient evaluation and scintigraphic test have not been able to adequately evaluate the nature of the motility disorder. The main indications for antroduodojejunal manometry are to evaluate unexplained nausea and vomiting, to differentiate neuropathic from myopathic disorders, and to evaluate for a diffuse GI motility disorder such as chronic intestinal pseudoobstruction. In some patients, test results can significantly alter patient management by changing the diagnosis and redirecting therapy. There are appropriate reimbursement codes available for gastric or duodenal manometry or for a combined procedure. Newer techniques are becoming available to assess GI motor function, even on an ambulatory basis. These include colonic manometry to evaluate children and even adults with chronic refractory constipation. More recently, a pH and pressure sensing capsule has been approved for assessing GI transit and contractility. Unlike studies with catheters, this freely floating capsule can assess both regional and whole gut transit of the stomach, small intestine and colon as the capsule traverses the GI tract. These newer tests, along with antroduodenojejunal manometry, better assist the neurogastroenterologist and gastroenterologist in arriving at a correct diagnosis and may help identify a more rational approach to treating patients with unexplained upper or lower GI symptoms.