Esophageal Manometry Interpretation Report

Patient name: [Patient full name]

DOB: [Date of birth]

MRN: [Medical record number]

Sex: [Sex as documented]

Facility: [Facility name]

Encounter type: [inpatient / outpatient]

Test date/time: [Date and time of manometry]

Ordering clinician and service: [Ordering clinician name and service]

Interpreting clinician: [Interpreting clinician name, credentials]

Study type: [High-resolution manometry (HRM) / Conventional manometry] [with impedance / without impedance]

System manufacturer: [Manufacturer] (Include only if documented; do not infer.)

Software: [Software name and version] (Include only if documented; do not infer.)

Catheter: [Catheter type/model] (Include only if documented; do not infer.)

Sensor configuration: [Number of sensors, spacing, circumferential vs unidirectional] (Include only if documented; do not infer.)

Indication

[Indication summary including primary symptom(s), duration/severity, whether structural disease was excluded, pertinent history such as prior foregut interventions, and medications known to affect motility] (1–3 sentences; include only details explicitly documented.)

Protocol Performed

• Patient preparation: [Fasting interval; medications held; positioning limitations] (Include only if documented.)
• Catheter placement: [Placement route; method of confirming gastric position]
• Swallow protocol: [Number of single wet swallows analyzed]; [Bolus volume in mL]; [Inter-swallow interval]; [Positions tested: supine / upright / both]
• Provocative maneuvers:
  • MRS: [Number of sequences / not performed]
  • RDC: [Volume and method / not performed]
  • Solid/viscous swallows or test meal: [Details / not performed]
  (If any component was abbreviated or not completed, state why.)

Technical Quality and Symptoms

• Study completeness: [Complete / Abbreviated] [Reason if abbreviated]
• Artifacts/limitations: [Artifacts affecting interpretation such as cough, catheter migration, poor EGJ traversing, or positional limitations] (Omit line if none.)
• Symptoms during study: [Description and timing relative to maneuvers / not documented] (If symptoms were not documented, state "not documented" rather than omitting.)

Findings

Baseline Measurements

• EGJ/LES morphology: [EGJ morphology or LES–crural diaphragm relationship per site labeling scheme]
• Basal EGJ or LES pressure: [Value with units]
• EGJ contractile integral (EGJ-CI): [Value with units and reference method] (Include only if used at site.)
• UES: [Resting pressure with units]; [Relaxation adequate / incomplete] (Include if assessed.)
• [Statement of baseline assessment limitations] (Include only if baseline metrics were not reliably assessed due to artifact.)

Single Wet Swallows

(Report separately for each position tested. Note concordance or discordance when both positions are performed.)

• Supine position:
  • Swallows analyzed: [n]
  • Median IRP: [Value with units]; ULN: [Reference value]
  • Failed swallows: [Percent]%
  • Weak/ineffective swallows: [Percent]%
  • DCI: [Mean or median value with units]
  • Distal latency: [Summary]
  • Pressurization patterns: [Panesophageal / Intrabolus / Compartmentalized with frequency] (Omit if none.)
• Upright position:
  • Swallows analyzed: [n]
  • Median IRP: [Value with units]; ULN: [Reference value]
  • Failed swallows: [Percent]%
  • Weak/ineffective swallows: [Percent]%
  • DCI: [Mean or median value with units]
  • Distal latency: [Summary]
  • Pressurization patterns: [Panesophageal / Intrabolus / Compartmentalized with frequency] (Omit if none.)
• Positional concordance: [Concordant / Discordant with brief comment] (Include only if both positions tested.)

(If only one position was tested, state which was omitted and why if known.)

Provocative Maneuvers

• Multiple Rapid Swallows (MRS): [Not performed] or [Number of sequences; deglutitive inhibition present/absent; post-MRS contraction amplitude; contractile reserve present/absent]
• Rapid Drink Challenge (RDC): [Not performed] or [Volume and method; EGJ relaxation during challenge; pressurization pattern if present]
• Solid/viscous swallows or test meal: [Not performed] or [Key abnormalities; symptom reproduction if any]
• Impedance findings: [Bolus transit and clearance patterns] (Include only if impedance was used.)

Interpretation

Classification framework: [Chicago Classification v4.0 / other framework with version]

Normative dataset: [Manufacturer/catheter-specific dataset; position-specific thresholds; site-specific modifications if any]

Diagnostic statement: [Conclusive / Inconclusive] diagnosis of [Diagnosis or manometric pattern]. [Brief objective criteria met and maneuvers supporting diagnosis]. [Caveats regarding potential mechanical obstruction, catheter artifact, or medication effects if applicable].

(Apply classification-based diagnostic labels only when protocol is adequate and required maneuvers were performed. If limited, use: "manometric pattern suggestive of [diagnosis]; classification limited by [missing element]." For inconclusive findings, specify what additional testing would strengthen diagnostic confidence.)

Impression

[Conclusive manometric findings consistent with [Diagnosis], [subtype if applicable], per [Framework version]] or [Inconclusive manometric pattern of [Pattern]; supportive testing recommended.]

• [EGJ morphology or hiatal hernia pattern] (Include if relevant.)
• [Contractile reserve status] (Include if assessed.)
• [UES abnormalities] (Include if relevant.)
• [Symptom reproduction during study] (Include if documented.)

Recommendations

• [Recommendations tailored to diagnosis] (Begin each with action verb such as "Consider," "Recommend," or "Correlate with." Frame as referral considerations rather than treatment directives. For achalasia spectrum, note subtype may influence therapy selection. For EGJOO pattern, recommend supportive testing before irreversible interventions. For hypomotility, note implications for reflux clearance and surgical planning. For inconclusive diagnoses, specify which additional tests would be helpful.)

Interpreting clinician electronic signature: [Name, credentials]

Date/time of interpretation: [Date and time]