Esophageal manometry is a diagnostic test that measures muscle contractions in the esophagus, which is the muscular tube that connects the throat to the stomach.
Utilizing a long, pressure-sensing tube called a catheter that’s passed down the esophagus, the esophageal manometry test is designed to measure the coordination and strength of the esophageal muscles that help a person swallow.
The main instrument utilized during an esophageal manometry test is a narrow, flexible, pressure-sensitive tube called a catheter. Usually passed through the nose and down the throat, this catheter has pressure sensors along its length.
Once inserted down the esophagus, the catheter used in esophageal manometry measures the pressure created by the esophagus muscles and the valves at the top and bottom of the esophagus as a patient swallows.
Known as the upper esophageal sphincter and lower esophageal sphincter, these valves control how and when food enters and leaves the esophagus. Abnormal contractions in the muscles and valves of the esophagus can cause swallowing problems and other issues.
The lower esophageal sphincter in particular plays a crucial role in keeping stomach acid from flowing back into the esophagus, preventing a condition known as gastroesophageal reflux disease (GERD).
High resolution esophageal manometry is an advanced version of the esophageal manometry test. It uses a catheter with many more sensors along its length that are also closer together. Having more sensors means high resolution esophageal manometry can collect more data and collect it faster.
Esophageal manometry is used to test whether the muscles in the esophagus are working properly.
When the muscles of the esophagus don’t work as they should, patients may experience symptoms such as heartburn, difficulty swallowing, choking, chest pain and regurgitation (vomiting after swallowing). Esophageal manometry can help determine what is causing these symptoms.
Esophageal Manometry is often used to identify the cause of swallowing problems and upper GI symptoms like gastric reflux, heartburn or chest pain. It can also be helpful in diagnosing and managing conditions of the esophagus, including:
Esophageal motility disorders, including diffuse esophageal spasm, which causes uncoordinated esophageal contractions while swallowing
Achalasia, a condition in which the lower esophageal sphincter doesn’t relax, which prevents swallowed food and drink from leaving the esophagus
Gastroesophageal reflux disease (GERD), which is a chronic condition in which stomach acid frequently flows back into the esophagus
Esophageal manometry can sometimes be used to help diagnose scleroderma, a rare connective tissue disorder that may cause muscles in the esophagus to stop working. Scleroderma causes the body to overproduce a type of connective tissue called collagen, which can accumulate in tissues.
Scleroderma can impact any organ or muscle in the GI tract, including the esophageal muscles, replacing muscle tissue and nerve fibers with collagen. This can lead to lack of coordination of the muscles in the esophagus. Esophageal manometry can potentially diagnose the issue and pinpoint where it’s occurring.
The esophageal manometry test and the barium swallow study are both used to diagnose swallowing difficulties and other related issues, but they are performed very differently.
A barium swallow test involves drinking a thick solution containing barium sulfate, which is a contrast agent that absorbs X-rays and shows up as white on an X-ray images. As the barium is swallowed, it coats the tissues, allowing them to be seen more easily on X-rays. This can help doctors more easily see abnormalities in the esophagus and related tissues.
Esophageal manometry uses a device called a catheter, which is fitted with sensors that reveal the pressure exerted by the muscles in the esophagus as you swallow. It can detect issues with muscle contractions along the esophagus, including contractions that are abnormally strong or weak.
Your physician will provide specific instructions to follow before the procedure, and you should be sure to follow them exactly. Common instructions patients receive before an esophageal manometry test include:
Tell your doctor about any medications you take, including over-the-counter medicines, vitamins, herbal supplements and prescription medications
Don’t eat or drink anything for several hours before the test. Patients are often asked to stop eating and drinking at midnight the night before the test
You’ll likely be asked to go ahead and take any daily, prescribed medications with a only sip of water.
Be sure to tell your doctor if you’re allergic to any medications, latex, etc.
Esophageal manometry is often performed as an outpatient procedure, unless it is conducted as part of a longer hospital stay. During the esophageal manometry procedure, you can generally expect the following:
To begin, you’ll sit upright on a table that can be reclined to a flat position. To help keep you comfortable and control the gag reflex, a specialist called a motility nurse will likely apply numbing gel to one of your nostrils and numbing spray to the back of your throat.
Once your nose and throat are numbed, a narrow catheter will be passed through one nostril and down the throat while the specialist asks you to swallow several times.
As you swallow, the catheter will be drawn down the esophagus until it reaches the stomach. The catheter is attached to a device which will help collect and interpret the data the catheter produces.
Unless instructed otherwise, you should be able to breathe and talk normally, but you will likely be required to stay very still. If you experience pain or trouble breathing, tell the specialist immediately.
Once the catheter is in place, you will then take drinks of water as instructed, with the specialist telling you how much and how fast to drink. The specialist may move the catheter during the procedure to measure pressure in different parts of the esophagus.
As you perform various swallowing exercises, the catheter’s pressure sensors measure how your esophagus muscles contract and relax. The data is sent to a computer that records your swallowing patterns for a doctor to analyze. The test usually takes about half an hour. When the test is over, the specialist will remove the catheter slowly. Unless your doctor instructs you differently, you can return to your normal diet and activities immediately after the test.
The process of placing the catheter in the esophagus will likely be uncomfortable, but should not be painful. However, as the catheter is drawn down the throat, you may gag and your eyes may water. After the test, you may have temporary soreness in your nose or a sore throat.
Your doctor should contact you a few days after the procedure to discuss the test and what the results have revealed about the function of your esophagus.
Though esophageal manometry can often help diagnose swallowing disorders, esophageal motility issues and other conditions of the esophagus, sometimes the results don’t indicate a definite cause. Whether the results of your esophageal manometry test are abnormal or not, you may be asked to take more diagnostic tests.
Esophageal manometry is generally considered a safe procedure. Common issues experienced by patients after esophageal manometry include a mild sore throat, temporary soreness in the nose or a minor nosebleed. These issues are normal and shouldn’t be cause for undue alarm.
Serious complications during or after an esophageal manometry test are very rare, but but include can include:
Perforation of the esophagus, in which the catheter penetrates the wall of the esophagus
Irregular heartbeat (arrhythmia)
Aspiration, in which a patient vomits and inhales stomach contents into the lungs