Esophageal manometry

Definition

Esophageal manometry (muh-NOM-uh-tree) is a test that gauges how well your esophagus works. Your esophagus is the long, muscular tube that connects your throat to your stomach.  Esophageal manometry measures the rhythmic muscle contractions (peristalsis) that occur in your esophagus when you swallow. Esophageal manometry also measures the force, or amount of pressure, exerted by the muscles of your esophagus.

During esophageal manometry, a thin, flexible tube (catheter) that contains sensors is passed through your nose, down your esophagus and into your stomach. You then swallow sips of water. Esophageal manometry can be helpful in diagnosing a variety of disorders that affect your esophagus. Esophageal manometry also may be used as part of a preoperative evaluation before anti-reflux surgery.

Why it's done

Esophageal manometry is used to evaluate the function of the muscles of your esophagus - the tube that connects your throat to your stomach. Circular bands of muscle (sphincters) at the top and bottom of your esophagus open and close to let food pass, while preventing a backwash of stomach acid. Other muscles in the wall of your esophagus help push food toward your stomach.

Esophageal manometry allows your doctor to measure the pressure, strength and pattern of your esophageal muscle contractions when you swallow to determine if your esophagus is working properly.

Your doctor may recommend esophageal manometry if you're experiencing symptoms that could be related to an esophageal disorder. Those symptoms may include:

• Difficulty swallowing (dysphagia)
• Pain when swallowing (odynophagia)
• Chest pain that's not related to a heart problem

Esophageal manometry may be used to help diagnose the following conditions:

• Achalasia. This condition occurs when your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach. Muscles in the wall of your esophagus are often weak as well. This can cause regurgitation of food not yet mixed with stomach contents, sometimes causing you to bring food back up into your throat.
• Diffuse esophageal spasm. This condition produces multiple, forceful, poorly coordinated muscle contractions of your esophagus, usually after you swallow.
• Nutcracker esophagus. In this condition, food may progress to your stomach normally, but the contractions of your esophageal muscles are painfully strong.
• Scleroderma. This rare progressive disease can cause hardening and tightening of the connective tissues within your esophagus.

Your doctor may also recommend esophageal manometry if you're considering undergoing anti-reflux surgery to treat gastroesophageal reflux disease (GERD). Esophageal manometry can help determine if you're a good candidate for the procedure and identify the right type of anti-reflux surgery for your situation.

Risks

Esophageal manometry is generally safe, and complications are rare. But as with any medical procedure, it does carry a risk of complications.

During esophageal manometry, you may experience:

• Gagging when the tube passes into your throat
• Watery eyes
• Slight nosebleed
• Discomfort in your nose and throat

After esophageal manometry, you may have some mild side effects, including:

• Sore throat
• Stuffy nose
• Minor nosebleed

Rarely, severe complications may include:

• Irregular heartbeat
• Stomach contents flowing back into your esophagus that you breathe into your lungs (aspiration)
• A hole in your esophagus (perforation)

How you prepare

You may need to avoid eating and drinking for a certain amount of time before esophageal manometry. Your doctor will give you specific instructions. Also, tell your doctor about any medications you are taking. You may be asked not to take some medications before the test.

What you can expect

Esophageal manometry is an outpatient procedure done without sedation. Most people tolerate it well. You may be asked to change into a hospital gown before the test starts.

During esophageal manometry

• While you are sitting up, a member of your health care team sprays your throat with a numbing medication or puts numbing gel in your nose or both.
• A catheter is guided through your nose into your esophagus. The catheter may be sheathed in a water-filled sleeve. It doesn't interfere with your breathing. However, your eyes may water, and you may gag. You may have a slight nosebleed from irritation.
• After the catheter is in place, you may be asked to lie on your back on an exam table, or you may be asked to remain seated.
• You then swallow small sips of water. As you do, a computer connected to the catheter records the pressure, strength and pattern of your esophageal muscle contractions.
• During the test, you'll be asked to breathe slowly and smoothly, remain as still as possible and swallow only when you're asked to do so.
• A member of your health care team may move the catheter down into your stomach while the catheter continues its measurements.
• The catheter then is slowly withdrawn.

The test usually lasts 20 to 30 minutes.

After esophageal manometry
When your esophageal manometry is complete, you may return to your normal activities.

Results

The results of your esophageal manometry will be sent to your doctor. Generally, results of esophageal manometry are ready in one to two days. The test results may be used to guide further treatment if necessary or to help plan a surgical procedure if the test was part of a preoperative assessment. Plan to discuss the results with your doctor at a follow-up appointment.