Esophageal manometry is a test used to measure the function of the lower esophageal sphincter (the valve that prevents reflux of gastric acid into the esophagus) and the muscles of the esophagus.
This test will tell your doctor if your esophagus is able to move food to your stomach normally. To know why you might be experiencing a problem with your digestive system, it helps to understand the swallowing and digestive processes.
The manometry test is commonly given to people who have:
- Difficulty swallowing
- Pain when swallowing
- Chest pain
- The swallowing and digestive processes
When you swallow, food moves down your esophagus and into your stomach with the assistance of a wave-like motion called peristalsis. Disruptions in this wave-like motion may cause chest pain or problems with swallowing.
In addition, the muscular valve connecting the esophagus with the stomach, called the esophageal sphincter, prevents food and acid from backing up out of the stomach into the esophagus.
If this valve does not work properly, food and stomach acids can enter the esophagus and cause a condition called gastroesophageal reflux disease (GERD).
Manometry will indicate not only how well the esophagus is able to move food down the esophagus but also how well the esophageal sphincter is working to prevent reflux.
What are the side effects of esophageal manometry?
Although esophageal manometry may be slightly uncomfortable, the procedure is not really painful because the nostril through which the tube is inserted is anesthetized.
Once the tube is in place, patients talk and breathe normally. The side effects of esophageal manometry are minor and include mild sore throat, nosebleed, and, uncommonly, sinus problems due to irritation and blockage of the ducts leading from the sinuses and into the nose.
Occasionally, during insertion, the tube may enter the larynx (voice box) and cause choking. When this happens, the problem usually is recognized immediately, and the tube is rapidly removed.
When is esophageal manometry used?
Esophageal manometry is used primarily in several situations. The first is to evaluate the cause of reflux of stomach acid and contents back into the esophagus (gastroesophageal reflux disease or GERD). Symptoms of GERD include heartburn and regurgitation.
The second is to determine the cause of problems with swallowing food, such as food or liquids getting stuck in the chest after swallowing. The third is to evaluate patients with chest pain that may be coming from the esophagus rather than the heart.
Finally, the test may be needed to correctly place an acid sensing probe (pH probe) in the esophagus.
How is esophageal manometry used?
Esophageal manometry can diagnose several esophageal conditions that result in food sticking after it is swallowed. For example, achalasia is a condition in which the muscle of the lower esophageal sphincter does not relax with each swallow to allow the swallowed food into the stomach.
As a result, food is trapped within the esophagus. Abnormal function of the muscle of the body of the esophagus may also result in food sticking.
For instance, there may be failure to develop the wave of muscular contraction to help propel the food down the esophagus (as can occur in patients with scleroderma).
The abnormal functioning of the esophageal muscle may also cause episodes of severe chest pain that can mimic heart pain (angina).
Such pain may occur if the esophageal muscle goes into spasm (esophageal spasm) or contracts too strongly. In either case, esophageal manometry can identify the muscular abnormality.
Esophageal manometry is also used to evaluate patients who might have gastroesophageal reflux disease (GERD). Manometry can often identify weakness in the lower esophageal sphincter – the muscle that prevents stomach acid and contents from refluxing back up into the esophagus.
The procedure will also help localize the lower esophageal sphincter which would help if esophageal pH monitoring is performed.
Before the test
Tell the physician if you have a lung or heart condition, have any other diseases, or have allergies to any medications
Please follow the instructions below (unless told otherwise by your doctor):
- One day (24 hours) before the test, stop taking calcium channel blockers such as Calan®, Isoptin® (verapamil); Adalat®, Pro-cardia® (nifedipine); and Cardizem®(diltiazem). Also stop taking nitrate and nitroglycerin products such as Isordil® (isosorbide); Nitrobid®, Nitrodisc®, Nitrodur®, Nitrogard®, Transderm-Nitro®, and Tridil®
- Twelve hours before the test, do not take sedatives such as Valium® (diazepam) or Xanax® (alprazolam)
- Do not stop taking any other medication without first talking with your doctor.
Preparation for the esophageal manometry test:
- Do not eat or drink after midnight the night before the test, until your test is over.
- Medications that need to be taken regularly, such as high blood pressure and heart medication, can be taken with small sips of water when you awaken in the morning.
- If you have diabetes, skipping breakfast may affect your need for diabetic medication. Generally, one-half of your usual dose of diabetic medication is taken in the morning of the test. This should be reviewed with your physician or health care provider.
- Medications that are not essential should not be taken on the day of the test until after the test is completed.
These medications include:
- Pain medicines such as Demerol®, codeine, morphine, Percodan®, and Percocet®
- Sedatives or tranquilizers, such as Valium®, Librax®, Ativan®, Elavil®, and Thorazine®
- Antispasmodics, such as Bentyl®, Donnatal®, Levsin®, and Robinul®
- Promotility agents such as Reglan® (metoclopramide), Zelnorm® (tegaserod), erythromycin, and Motilium® (domperidone)
If you have questions about a specific medication, ask your physician or nurse.
During the test
You are not sedated. However, a topical anesthetic (pain-relieving medication) will be applied to your nose to make the passage of the tube more comfortable.
A small, flexible tube is passed through your nose, down your esophagus and into your stomach. This tube is a high-resolution manometry catheter that is about 4 mm in diameter.
The tube does not interfere with your breathing. You will be seated while the tube is inserted.
You may feel some discomfort as the tube is being placed, but it takes only about a minute to place the tube. Most patients quickly adjust to the tube’s presence. Vomiting and coughing are possible when the tube is being placed, but are rare.
After the tube is inserted, you will be asked to lie on your left side. The end of the tube exiting your nose is connected to a machine that records the pressure exerted on the tube.
Sensors at various locations on the tubing sense the strength of the lower esophageal sphincter and muscles of the esophagus. During the test, you will be asked to swallow a small amount of water to evaluate how well the sphincter and muscles are working.
The sensors also measure the strength and coordination of the contractions in the esophagus as you swallow.
The test lasts 10 to 15 minutes. When the test is over, the tube is removed. The gastroenterologist will interpret the recordings that were made during the test.
After the test
Your physician will notify you when the test results are available or will discuss the results with you at your next scheduled appointment.
You may resume your normal diet and activities and any medications that were withheld for this test.
You may feel a temporary soreness in your throat. Lozenges or gargling with salt water may help.
If you think you may be experiencing any unusual symptoms or side effects, call your doctor.