Esophageal manometry is a test used to measure the function of the lower esophageal sphincter and the muscles of the esophagus.
The manometry test is commonly given to people who have difficulty in swallowing, pain on swallowing, heartburn and chest pain.
On swallowing, the food moves down the esophagus and into the stomach with the assistance of a wave-like motion called peristalsis. The muscular valve connecting the esophagus with the stomach, called the esophageal sphincter, prevents food and acid from backing up out of the stomach into the esophagus.
Manometry will tell abput esophageal musculature and sphincter both.
Indications for Esophageal manometry
- Noncardiac chest pain or esophageal symptoms not diagnosed by endoscopy
- Evaluation for achalasia or another nonobstructive dysphagia
- Preoperative evaluation for patients undergoing corrective surgery for gastro esophageal reflux disease
- Postoperative evaluation of dysphagia in patients who underwent corrective surgery for reflux or after treatment of achalasia
- Prior to esophageal pH monitoring to assess the location of the lower esophageal sphincter
- Evaluation of esophageal motility problems associated with systemic diseases
Esophageal manometry is contraindicated in the following situations:
- Patients with altered mental status or
- Inability to understand and follow instructions
- Obstructive lesions like tumors
Some conditions can lead to technical difficulties when performing esophageal manometry, such as achalasia, large hiatal hernias, intrathoracic stomach, and patients with prior esophageal surgery.
Equipment for esophageal manometry includes the following:
- Manometry catheter
- Manometer software with computer monitor
- Lidocaine spray
- Water-based lubricant
- Glass of water with straw
- Syringe, 60 mL
- Normal saline solution
- High ionic gel-consistency solution
- Adhesive tape to fix catheter
- Tissues (to offer to patient as needed throughout the procedure)
The patient should not eat or drink for at least 4 hours before the procedure though regular medications can be taken with a small amount of water.
The procedure must be done in a patient who is fully awake and conscious.
With the patient sitting upright, the pharynx and the nostril are anesthetized. In the same position, the catheter is passed through the nose, down the throat, and through the esophagus into the stomach while the patient takes small sips.
Then, thepatient is asked to lay down. Before stomach distal transducer shows an increase in pressure as it passes the lower esophageal sphincter, with a subsequent drop.
Aftger confirmation of cather in stomach, withdraw the catheter from the stomach, 1 cm at a time, keeping watch for an increase in pressure that will signal when the transducer is crossing the lower esophageal sphincter.
High-resolution esophageal manometry allows direct visualization.
The catheter should then be taped to the nose to keep it in place.
With the most distal circumferential transducer in the lower esophageal sphincter, give ten 5-mL water swallows to the patient with 20-30 seconds in between to evaluate the lower esophageal sphincter relaxation pattern and the contraction of the smooth-muscle distal esophagus. After these sips, pull the catheter out furthertill the pressure drops.
At this time, six 5-mL water swallows are performed.
Common Manometric Abnormalities
Gastroesophageal reflux disease
More than 95% of these patients have a basal lower esophageal sphincter pressure higher than 10 mm Hg. Esophageal body peristalsis can also be impaired.
The findings are not pathognomonic.
The classic manometric findings of achalasia include smooth muscle esophageal aperistalsis and impaired relaxation of the lower esophageal sphincter/esophagogastric junction.
The category of hypercontractile motility disorders has included nutcracker esophagus (increased mean amplitude >180 mm Hg with normal peristalsis and prolonged distal esophageal contraction) and hypertensive lower esophageal sphincter (g pressure greater than 45 mm Hg with possible impaired relaxation).
Esophageal manometry is a generally safe procedure, and complications are usually few and mild > Thes include, gagging and watery eyes during the catheter insertion, sore throat, rhinorrhea, and epistaxis). More severe complications occur rarely and may include arrhythmias, vasovagal episodes, bronchospasm, and aspiration.
The patient can resume his or her regular diet after the procedure.