Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Esophageal manometry is a procedure for determining how well the
muscle of the esophagus works when diseases of the muscle are
suspected by measuring pressures (manometry) generated by the esophageal muscles.
When is esophageal manometry used?
Esophageal manometry is used primarily in three situations.
To evaluate the esophagus when there is reflux (regurgitation) of stomach
acid and contents back into the esophagus (gastroesophageal reflux
disease or GERD)
To determine the cause of problems
with swallowing food (dysphagia)
When there is chest pain
that may be coming from the esophagus
How is esophageal manometry performed?
At the start of the esophageal manometry procedure, one nostril is
anesthetized with a numbing lubricant. A flexible plastic tube
approximately one-eighth inch in diameter is then passed through the
anesthetized nostril, down the back of the throat, and into the
esophagus as the patient swallows. Once inside the esophagus, the
tube allows the pressures generated by the esophageal muscle to be
measured when the muscle is at rest and during swallows. The
procedure usually takes 15 to 20 minutes.
How is esophageal manometry used
to assist in the diagnosis of diseases and conditions?
The esophagus is a muscular tube that connects the throat with the
stomach. When food is propelled by a swallow from the mouth into the
esophagus, a wave of muscular contraction starts behind the food in
the upper esophagus and travels down the entire length of the
esophagus (referred to as the body of the esophagus), thus propelling the
food in front of the wave through the esophagus and into the stomach. At the
upper and lower ends of the esophagus are two short areas of
specialized muscle called the upper and lower esophageal sphincters.
At rest (that is, when there has been no swallow) the muscle of the
sphincters is active and generates pressure that prevents anything
from passing through them. As a result, material within the
esophagus cannot back up into the throat, and stomach acid and
contents cannot back up into the esophagus. When a swallow occurs, both
the sphincters relax for a few seconds to allow food to pass through the
esophagus into the stomach.
The most common use for esophageal manometry is to evaluate the lower
esophageal sphincter and the muscle of the body of the esophagus in patients who have gastroesophageal reflux
disease (GERD). Manometry often can identify weakness in the lower
esophageal sphincter that allows stomach acid and contents to back up
into the esophagus. It also may identify abnormalities in the functioning of the
muscle of the esophageal body that may add to the problem of reflux.
Manometry can help 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 completely with each swallow. As a result, food is trapped within the
esophagus. Abnormal function of the muscle of the body of the
esophagus also may result in food sticking. For instance, there may
be failure to develop the wave of muscular contraction (as can occur
in patients with scleroderma) or the entire esophageal muscle may
contract at one time (as in an esophageal spasm). Manometry reveals
an absence of the wave in the first case and the contraction of the
muscle everywhere in the esophagus at the same time, or spasm, in the
second case.
The abnormal functioning of the esophageal muscle also may cause
episodes of severe chest pain that can mimic heart pain (angina).
Such pain may occur if the esophageal muscle goes into spasm or
contracts too strongly. In either case, esophageal manometry may
identify the muscular abnormality.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:
Candida. This is a yeast infection of the esophagus caused by the same fungus that
causes vaginal yeast infections. The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or
HIV). It is usually very treatable with antifungal drugs.
Herpes. Like Candida, this viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.
Irritation causing esophagitis may be caused by any of the following:
GERD, or gastroesophageal reflux disease
Vomiting
Surgery
Medications such as aspirin and other anti-inflammatory drugs
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