Using conventional manometry, the majority of patients with massive paraesophageal hiatal hernias will present with a hypotensive lower esophageal sphincter (LES) and hypotensive peristalsis in the distal esophageal body; however, there are no reports on the use of high resolution manometry (HRM) in patients with an intrathoracic stomach.
Aim: This study aims to evaluate the manometric pattern found in patients with an intrathoracic stomach using HRM.
Methods: We reviewed 10 patients (9 females, median age 62 years) who were found to have an intrathoracic stomach, as defined by a large paraesophageal hernia with more than 50% of the stomach in the mediastinum on barium esophagography. Nine patients had a type III hernia and one patient had a type IV hernia. All patients underwent HRM in our laboratory.
Results: Results are expressed in the table below.The LES was hypotensive (<6mmHg) in 1 (10%) patient and hypertensive (>28mmHg) in 2 (20%) patients. Distal esophageal amplitude was hypotensive in 1 (10%) patient. Proximal esophageal amplitude was hypotensive (<30mmHg) in 3 (30%) patients.
Conclusion: Most patients with an intrathoracic stomach have normal manometric findings on HRM.

	Median	Range
LES length (cm)	2.4	2.3-3.3
LES midrespiratory pressure (mmHg)	19.5	1.6-45.9
Distal esophageal amplitude (mmHg)	70.9	26.2-162.7
Proximal esophageal amplitude (mmHg)	35.9	23.9-65.7
Peristaltic waves (%)	100	80-100
Upper sphincter pressure (mmHg)	44.1	21.6-105.6
Esophageal length (cm)	18.5	15.5-22.7