Esophageal manometry is a diagnostic test that evaluates the function of the esophagus, the muscular tube connecting your throat to your stomach. This procedure measures the strength and coordination of the esophageal muscles, providing insight into their ability to move food and liquids. It helps assess esophageal motor function, helping medical professionals understand if swallowing and food transport occur as intended.
Understanding Esophageal Function
The esophagus transports swallowed food and liquids from the mouth to the stomach. This muscular tube relies on a coordinated series of contractions to propel its contents downward. At both ends of the esophagus are ring-shaped muscles called sphincters, which regulate passage and prevent reflux.
The upper esophageal sphincter (UES) is located at the top, opening to allow food to enter the esophagus from the throat. The lower esophageal sphincter (LES) is situated at the junction where the esophagus meets the stomach. This lower sphincter relaxes to permit food into the stomach and then closes to prevent stomach contents from flowing back into the esophagus. The rhythmic, wave-like muscle contractions that move food through the esophagus are called peristalsis. This process involves a sequential contraction of muscles above the food bolus and relaxation below it, ensuring efficient downward movement.
When Esophageal Manometry is Recommended
Esophageal manometry is often recommended for symptoms suggesting esophageal muscle dysfunction. Difficulty swallowing, known as dysphagia, is a common reason for this test, particularly when it affects both solid foods and liquids. Non-cardiac chest pain, which is chest discomfort not related to heart conditions, can also prompt a recommendation for manometry.
The test is also considered for acid reflux (GERD) that does not respond to standard treatments, as it can identify underlying motility issues. Furthermore, it is often performed before certain anti-reflux surgeries to ensure adequate esophageal function. Manometry helps diagnose specific esophageal motility disorders, such as achalasia, where the LES fails to relax properly and peristalsis is impaired. It can also identify diffuse esophageal spasm, characterized by disorganized and forceful contractions, or ineffective esophageal motility, where contractions are weak or absent.
The Procedure Explained
Preparation for an esophageal manometry involves fasting for at least six hours before the test to ensure the esophagus is empty. Patients are also usually advised to discuss their medications with their healthcare provider, as some drugs, such as calcium channel blockers or nitrates, might need to be temporarily stopped 24 hours prior because they can affect esophageal muscle function.
During the test, a thin, flexible catheter containing pressure sensors is gently guided through one nostril, down the throat, and into the esophagus. A numbing gel or spray is applied to the nostril and throat beforehand to minimize discomfort during insertion. Patients remain awake and often sit upright or lie on their back during the procedure.
Once the catheter is in place, baseline readings are taken. The patient is then asked to swallow small sips of water, allowing the sensors to record the pressure and coordination of muscle contractions. The procedure generally takes 30 to 45 minutes.
Post-Procedure and Results
After an esophageal manometry, patients can typically resume normal diet and activities immediately. Some individuals may experience minor sensations such as a mild sore throat, a stuffy nose, or slight irritation in the nasal passage, which usually resolve within a few hours. Throat lozenges or gargling with salt water can help alleviate discomfort.
The data collected during the procedure, which includes pressure readings and patterns of muscle activity, is then analyzed by a specialist. This analysis helps determine the strength and coordination of peristalsis and how well the upper and lower esophageal sphincters open and close. Abnormal findings can indicate various motility disorders, such as a weak or overly tight lower esophageal sphincter, or uncoordinated esophageal contractions. The results provide objective information that helps healthcare providers diagnose esophageal dysfunction and guide treatment decisions.