(1) Normal esophageal HRM shows decreasing pressure during inspiration and increasing pressure during expiration at rest, and characteristic pressure patterns after wet swallows including striated muscle contraction in S1 and smooth muscle contractions in S2 and S3. (2) Common artifacts in HRM include vascular artifacts seen as rhythmic distal esophageal pressure, folded catheter artifacts appearing as mirrored pressure patterns, sensor failure artifacts visible as solid bands of pressure or chatter, and air entrapment artifacts causing very high measured pressures along the entire catheter length. (3) Artifacts can potentially provide useful information but must be distinguished from normal patterns, and issues like a folded catheter require repositioning to avoid damage.

1. Artifacts in esophageal
high resolution manometry
Samir Haffar M.D.

2. Artifacts in esophageal
high resolution manometry
• Normal esophageal HRM at rest & after wet swallow
• Artifacts in HRM: (1) Vascular artifacts
(2) Folded catheter artifact
(3) Sensor failure artifact
(4) Air entrapment artifact

3. Normal esophageal HRM

4. Normal esophageal HRM at rest
Conklin J et al. ACG Annual Postgraduate Course - October 12-13, 2013
Intra-eophageal pressures decrease in inspiration
& increase in expiration

5. HRM atlas – Medical measurement Systems
Normal esophageal HRM after a wet swallow
esophageal pressure topography

6. Normal esophageal HRM after a wet swallow
esophageal pressure topography (Clause's segments)
Conklin JL. J Neurogastroenterol Motil 2013; 19(3):281-294.
5 ml wet swallow
S1: striated esophageal muscles
Transition zone: pressure between S1 & S2
S2 & S3: proximal & distal smooth muscles
S4: LES repositioning at its resting position

7. Artifacts in esophageal HRM

8. Artifacts in esophageal HRM
(1) Vascular artifacts
(2) Folded catheter artifact
(3) Sensor failure artifact
(4) Air entrapment artifact

9. (1) Vascular artifacts

10. Vascular artifacts
Roman S et al. Clin Gastroenterol Hepatol 2011; 9(12): 1050–1055.
Vascular artifact observed in the distal esophagus

11. Potentially useful vascular artifacts
Patient complaining of dysphagia
Elevated resting intraesophageal pressure at 26 & 31 cm from nares
Rhythmic pressure at rate of 80/min (cardiovascular artifacts)
Suspicion of dysphagia Lusoria
Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.

12. (2) Folded catheter artifact

13. Folded catheter artifact / Mirror image
Normal peristalsis to about 43
Simultaneous pressure from 43 to 49 cm
Reverse peristalsis below 49 cm
Pressure from 46-54 mirror image of 38-46 cm
Catheter folded upon itself
Catheter repositioned to avoid its damage
Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.

14. Folded catheter artifact / Butterfly pattern
Gyawali CP et al. Neurogastroenterol Motil 2013; 25:99–133.
Catheter coiled in the esophagus
Swallow followed by peristaltic esophageal contraction
This contraction pattern mirrors at level of curling catheter

15. (3) Sensor failure artifact

16. Sensor failure artifact
Sensor failure may be seen as solid bands of color (*)
or an irregular “chatter” in the color contour (top of the contour)
Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.

17. (4) Air entrapment artifact

18. Air entrapment artifact
Seen when there is air between protective sheath & catheter
Very high bolus pressure transmitted all the way to end of catheter
(double-headed arrow)
Conklin J, Soffer E, & Pimentel M. Color atlas of high resolution manometry, Springer, 2009.

19. Thank You