Esophageal Manometry

The esophagus is the tube that carries food and liquid from the throat to the stomach. The wall of the esophagus contains muscle that rhythmically contracts whenever a person swallows. This contraction occurs as a sweeping wave (peristalsis) carrying food down the esophagus. It literally strips the food or liquid from the throat to the stomach.

Another important part of the esophagus is the lower esophageal sphincter, or LES. This is a specialized muscle that remains closed most of the time, only opening when swallowed food or liquid is moved down the esophagus or when a person belches or vomits. This muscle protects the lower esophagus from caustic stomach acid and bile. These substances can cause the discomfort of heartburn and in time can lead to damage and scarring in the esophagus.

Manometry is the recording of pressures within the esophagus. It can evaluate the contraction amplitude and coordination of the stripping muscle waves in the main portion of the esophagus as well as in the lower esophageal sphincter (LES).

Reasons for the Exam

There are a number of symptoms that originate in the esophagus. These include difficulty swallowing food or liquid, heartburn, and chest pain. Additionally, an x-ray (barium swallow or upper GI series) or endoscopy may show abnormalities that need to be studied further by manometry. The exam is often done before surgical treatment for heartburn/ gastsroesophageal reflux disease.

Preparation

The preparation for esophageal manometry is very simple. The patient should take no food or liquid for about eight hours before the exam. Your usual medications may be taken with small sips of water on the day of the exam. As the examination will be performed without sedative medications, you may drive yourself to and from the examination. Certain medications (such as Reglan/metaclopramide) may be held prior to the procedure as they may affect the contractility of the esophagus.

The Procedure

The procedure takes about one hour from start to finish. While seated in a chair or lying on the side, thin soft tubing is gently passed through the nose, or occasionally the mouth. Upon swallowing, the tip of the tube enters the esophagus and the technician then quickly passes it down to the desired level. There is usually some slight gagging at this point, but it is easily controlled by following instructions. During the exam, the technician will ask you to swallow saliva (called a dry swallow) or water (called a wet swallow). Pressure recordings are made and the tubing is withdrawn. Patients can usually resume regular activity, eating, and medicines immediately after the exam.

Results

The manometry tracings are performed by the technician, but interpreted by your physician. You will be contacted regarding the results which help to determine the appropriate next step in diagnosis and treatment.

Benefits

The primary benefit of the exam is that the physician has clear documentation of the muscle function of the esophagus. With this information, a specific treatment program can be outlined or reassurance provided if the exam is normal.

Alternatives to Manometry

Nothing really takes the place of manometry. Other techniques that are used to study the esophagus include: upper GI x-ray series using swallowed liquid barium; upper endoscopy to visualize the inside lining of the esophagus; and a 24-hour probe left in the end of the esophagus to measure acidity as it refluxes from the stomach.

Side Effects and Complications

There minimal risks associated with manometry. Theoretically, esophageal tear/ perforation and/or bleeding could occur, but this complication is extremely rare. Slight gagging is normal during the exam, and a temporary sore throat may be present afterward.

Summary

“Esophageal manometry” is a very valuable method of recording and evaluating the muscular function of the esophagus. The test is simple and quick to perform. With this information, the physician can usually develop effective treatment for most patients with esophageal muscle disorders.

 

Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

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