Esophageal Manometry
(Esophageal Motility)

Digestive Disease Myths Slideshow

• What is esophageal manometry?
• When is esophageal manometry used?
• How is esophageal manometry performed?
• How is esophageal manometry used?
• What limitations are there to the use of esophageal manometry?
• What are the side-effects of esophageal manometry?
• Are there alternatives to esophageal manometry?

What is esophageal manometry?

Esophageal manometry is a procedure for determining how well the muscle of the esophagus works when diseases of the muscle are suspected.

When is esophageal manometry used?

Esophageal manometry is used primarily in three situations. The first is to evaluate the cause of reflux (regurgitation) of stomach acid and contents back into the esophagus (gastroesophageal reflux disease or GERD). The second is to determine the cause of problems with swallowing food. The third is 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 takes 20 to 30 minutes.

How is esophageal manometry used?

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) propelling the food in front of it down 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, the sphincters relax for a few seconds to allow food to pass.

The most common use for esophageal manometry is to evaluate the lower esophageal sphincter 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.

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. 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 can identify the muscular abnormality.

Next: What limitations are there to the use of esophageal manometry? »

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