Esophageal manometry

Overview

Esophageal manometry (muh-NOM-uh-tree) is a test that shows how well the esophagus is working. It measures muscle contractions of the esophagus as water moves through to the stomach. This test can be helpful in diagnosing esophageal conditions, especially if you have trouble swallowing.

The esophagus is a long, muscular tube that connects the mouth to the stomach. When you swallow, your esophagus squeezes from top to bottom. These contractions push food into the stomach. Esophageal manometry measures the strength of these contractions. Also, it shows how well these muscles work together to move food.

During esophageal manometry, a thin, flexible tube is passed through the nose. This tube, also called a catheter, has pressure sensors. It goes down the esophagus and into the stomach.

Esophageal manometry might be used to help diagnose these rare conditions:

• Achalasia. In this condition, the lower esophageal sphincter muscle doesn't relax enough to let food enter the stomach. Symptoms include trouble swallowing and food coming back up the throat.
• Diffuse esophageal spasm. This happens when contractions of esophageal muscles are frequent, forceful and out of sync. This can result in trouble swallowing or chest pain.
• Scleroderma. In scleroderma, muscles in the lower esophagus stop moving, causing severe gastroesophageal reflux (GERD). Scleroderma is a progressive condition.

Why it's done

Your care team might suggest esophageal manometry if you have symptoms that raise concerns about how your esophagus is working.

Esophageal manometry shows movement patterns as water flows from the esophagus to the stomach. The test measures the muscles at the top and bottom of the esophagus. These are called the sphincter muscles. The test shows how well these muscles open and close. Also, it measures the pressure, speed and wave pattern of muscle contractions along the esophagus when water is swallowed.

Other tests might be needed based on your symptoms. These tests show or rule out other issues such as esophageal narrowing, complete blockage or inflammation. If your main symptom is pain or trouble swallowing, you might need an x-ray or upper endoscopy. During an upper endoscopy, a healthcare professional uses a tiny camera on the end of a tube to see the upper digestive system. This includes the esophagus, stomach, and first 6 inches (15 centimeters) of the small bowel. This test is usually done before esophageal manometry.

If your healthcare professional has recommended anti-reflux surgery to treat GERD, you might need esophageal manometry first. This helps rule out achalasia or scleroderma, which GERD surgery can't treat.

If you've tried GERD treatments but still have chest pain not caused by your heart, your care professional might recommend esophageal manometry.

Risks

Esophageal manometry is generally safe, and complications are rare. However, you may have some discomfort during the test, including:

• Gagging when the tube passes into your throat.
• Watery eyes.
• Irritation in the nose and throat.

After esophageal manometry, you might have mild side effects. These often resolve within hours. Side effects can include:

• Sore throat.
• Stuffy nose.
• Minor nosebleed.

How you prepare

Your stomach should be empty before esophageal manometry. Your healthcare professional tells you when to stop eating and drinking before the test. Also, tell your health professional about medicines you take. You might be asked to stop taking some medicines before the test.

What you can expect

This test is done as an outpatient procedure. You will be awake while it happens, and most people tolerate it well. You might change into a hospital gown before the test starts.

During esophageal manometry

• Your nose and throat are numbed. While you are seated, a member of your healthcare team sprays your throat with a numbing medicine or put numbing gel in your nose or both.
• A catheter is placed. A catheter is guided through your nose into your esophagus. The catheter may be covered by a water-filled sleeve. The catheter doesn't interfere with your breathing. However, your eyes might water, and you might gag. You might have a slight nosebleed from irritation.
• You are positioned on a table. After the catheter is in place, you are asked to lie on your back on an exam table or to remain seated.
• You swallow water. Next, you swallow small sips of water. As you do, a computer connected to the catheter records the pressure, speed and pattern of your esophageal muscle contractions.
• You remain calm and still. During the test, you're 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 healthcare team might move the catheter up or down into your stomach while the catheter continues its measurements.
• The catheter is slowly withdrawn.

The test usually lasts about 30 minutes.

After esophageal manometry

When your esophageal manometry is complete, you can return to your typical activities.

Results

Your care team gets the results of your esophageal manometry in 1 to 2 days. The test results can be used to make decisions before surgery or to help find the cause of esophageal symptoms. Plan to discuss the results with your care team at a follow-up appointment.