Esophageal Manometry Test: Procedure, Results, Risks (original) (raw)
What is the esophageal manometry test?
Esophageal manometry is a test used to assess the muscle function of the esophagus. It is often ordered in patients who have difficulty swallowing, pain with swallowing, difficult to control GERD.
Esophageal manometry is used to test how well the esophagus functions. The test measures how well the esophagus contracts and whether the muscles work together in sequence to move food from the mouth into the stomach.
The esophagus is a muscular tube that connects the mouth to the stomach. As part of the swallowing function, the esophagus rhythmically contracts to push food downward into the stomach.
Esophageal manometry also helps measure the function of the lower esophageal sphincter, a specialized muscle located where the esophagus enters the stomach that prevents stomach contents from refluxing or flowing backwards into the esophagus.
What are the types of esophageal manometry?
Esophageal manometry technology has improved and become more sophisticated. Now, the most common test performed is high resolution manometry, where sensors on the catheter are located 1 cm apart and can produce a detailed map of how the esophagus works during the swallowing process.
What is esophageal manometry with impedance?
While esophageal manometry measures how the muscles move, impedance testing is used to measure the acid level (pH) of the contents within the esophagus, and whether those contents are liquid or air.
The test is conducted over the course of 24 hours, where a small catheter is placed through the nose into the esophagus and left in place to collect data. The patient is sent home to keep a diary of eating and drinking, and of symptoms should they occur.
Normally, the pH of the esophagus is 7.0, or neutral. Should the impedance testing find the pH to be low (or acidic), the diagnosis of gastroesophageal reflux disease (GERD) can be made.
What does esophageal manometry test for?
Esophageal manometry is a test used to assess the muscle function of the esophagus. It is often ordered in patients who have difficulty swallowing, pain with swallowing, and difficult to control GERD.
It is often performed only after an endoscopy by a gastroenterologist has shown that there are no structural abnormalities, like a mass or tumor, in the esophagus.
Esophageal manometry may also be used to help diagnose unusual diseases like achalasia or scleroderma.
What is the procedure for esophageal manometry?
Esophageal manometry uses a thin catheter, or tube, threaded through the nose into the esophagus, to take pressure readings.
Commonly, the nose and the back of the throat are numbed with an anesthetic spray. A small catheter is then threaded through the nostril to the back of the throat, and with the help of the patient swallowing, the tube passes into the esophagus.
Next, the patient is asked to take sips of water, and the sensors on the catheter measure the muscle movements of the esophagus. These measurements help the gastroenterologist interpret whether the esophagus is working normally, or not.
Once the measurements are taken, the catheter is removed by pulling it back through the nose.
How long does the esophageal manometry test take?
Esophageal manometry usually takes about 30-45 minutes to complete.
Impedance testing places a catheter similar to manometry, but it is taped in place (usually behind the ear), and attached to a recorder that the patient wears for 24 hours. The patient needs to return to have the tube removed the day after it is inserted.
Are you sedated or awake for the esophageal manometry test?
There is no need for sedation for manometry testing.
Is esophageal manometry painful?
Placing a small catheter tube through the nose may be uncomfortable, but is tolerated well by most patients. As the tube enters the nose, it can cause eyes to water, and a minor nosebleed can occur. When the tube is felt in the back of the throat, some patients may gag. Once the tube enters the esophagus, the rest of the test continues with little difficulty.
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What are the results for esophageal manometry?
The purpose of manometry is to assess the muscle function of the esophagus.
The Chicago classification for esophageal motility disorders is one way of categorizing the results. The variety of esophageal diseases that cause difficulty in swallowing can be grouped as follows:
- Category I – Incomplete relaxation of the lower esophageal sphincter. (e.g. achalasia)
- Category II – Major disorders of peristalsis (e.g. distal esophageal spasm, hypercontractile esophagus, absent peristalsis)
Peristalsis is the term used to describe contraction and relaxation of the muscles along a tube. In the esophagus, peristalsis causes a wave movement that pushes food from the mouth towards, and into, the stomach.
- Category III – Minor peristalsis disorders
- Category IV – Normal esophagus function
Certain medications can affect the manometry test results and may need to be stopped for a few days before the test. Follow the instructions of your healthcare provider and do not stop medications on your own. Examples include:
- antacid medications like H2 blocker (e.g. famotidine) and proton pump inhibitors (e.g. omeprazole)
- calcium channel blockers (e.g. diltiazem, amlodipine)
- nitrates (e.g. nitroglycerine, isosorbide)
- Opioids
- Caffeine
Previous esophagus surgeries and large hiatal hernias may also affect results of the test.
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What are the complications of esophageal manometry?
The major complication of esophageal manometry is the inadvertent placement of the catheter into the larynx, the upper part of the trachea, instead of the esophagus. This most often occurs in patients who cannot swallow on command.
The situation is quickly recognized by the gastroenterologist, because coughing begins immediately. It is corrected by having the catheter withdrawn and placed in the correct position in the esophagus.
As with any catheter placement, there is a risk of perforation, but with manometry it is exceedingly rare.
Esophageal manometry vs. endoscopy
Esophageal manometry measures function, while endoscopy defines the anatomy of the esophagus.
During endoscopy, the gastroenterologist can look directly at the lining of the esophagus and stomach, searching for abnormalities like masses, tumors, or abnormal blood vessels.
Esophageal manometry measures how well the muscles work to move from the mouth to the stomach. It is not meant to replace endoscopy, and is often performed after endoscopy has been completed and no anatomical abnormalities of the esophagus are found.
Esophageal manometry vs. barium swallow
A barium swallow can detect structural abnormalities of the esophagus and may be able to note some abnormalities of esophageal movement, but it cannot measure the strength of the esophagus contractions. Manometry can detect muscle movement through the whole length of the esophagus, determine how powerful or weak they might be, and whether those movements occur in a coordinated fashion.
Medically Reviewed on 8/20/2024
References
Yadlapati R, Kahrilas PJ, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021. 33(1):e14058.
Kahrilas PJ, Bredenoord AJ, et al. High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015. 27(2):160-74.
Yadlapati R. High-resolution esophageal manometry: interpretation in clinical practice. Curr Opin Gastroenterol. 2017. 33(4):301-309.