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 the muscle of the esophagus and the sphincter (valve) works by measuring pressures (manometry) generated by the esophageal muscles and the sphincter.
Esophageal manometry is used primarily in three situations:
To evaluate the function of the sphincter and muscles of 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 an endoscopy is normal
When there is chest pain that may be coming from the esophagus after the heart as a cause of chest pain has been ruled out
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.