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Esophageal Manometry

What is esophageal manometry?
Indications
Preparation
Procedure
Recovery

What is esophageal manometry?

The esophagus is the tube that carries food and liquid from the throat to the stomach. Although it seems like a simple organ, the esophagus is not a rigid tube. The wall of the esophagus a muscle that rhythmically contracts whenever a person swallows. This contraction occurs as a sweeping wave (peristalsis) carrying food down the esophagus. It literally strips the food or liquid from the throat to the stomach.

Another important part of the esophagus is the lower valve muscle (lower esophageal sphincter, or LES). This is a specialized muscle that remains closed most of the time, only opening when swallowed food or liquid is moved down the esophagus or when a person belches or vomits. This muscle protects the lower esophagus from caustic stomach acid and bile. These substances, of course, cause the discomfort of heartburn and in time can lead to damage and scarring in the esophagus. At times, everyone has heartburn, especially after a large or fatty meal.

Manometry is the recording of muscle pressures within an organ; esophageal manometry measures the pressure within the esophagus. It can evaluate the action of the stripping muscle waves in the main portion of the esophagus as well as the muscle valve at the end of it.

The equipment for manometry consists of thin tubing with openings at various locations. When this tube is positioned in the esophagus, these openings sense the pressure in various parts of the esophagus. As the esophagus squeezes on the tube, these pressures are transmitted to a computer analyzer that records the pressures on moving graph paper, much like an electrocardiogram. The physician can evaluate these wave patterns to determine if they are normal or abnormal.

Indications

There are a number of symptoms that originate in the esophagus. These include difficulty swallowing food or liquid, heartburn, and chest pain. Additionally, an x-ray (barium swallow or upper GI series) or endoscopy may show abnormalities that need further study by manometry. The exam is often done before and after medical or surgical treatment of the esophagus. Esophageal manometry is very effective in evaluating the contraction function of the esophagus in many situations. After the exam, the physician has clear documentation of the muscle function of the esophagus. With this information, a specific treatment program can be outlined, or reassurance can be provided if the exam is normal.

Preparation

The patient should take no food or liquid for about eight hours before the exam. The physician will usually (although not always) want to study the esophagus in its natural state.

The following drugs may affect the contractile pattern of the esophagus. They usually need to be discontinued at least 48 hours beforehand. Check with your physician about all your medications.

Caffeine/coffee
Reglan (generic: metoclopramide)
Urecholine (generic: bethanechol)
Erythromycin (antibiotic - many brand names)
Nitroglycerin (Isordil, Nitro-Bid, others)
Calcium channel blockers (Procardia, Adalat, Calan, cardizem, others)
Betablockers (Inderal, Corgard, others)
Donnatol
Librax
Levsin
Tagamet (generic: cimetidine)
Zantac (generic: ranitidine)
Pepcid (generic: famotidine)
Axid (generic: nizatidine)
Prilosec (generic: omeprazole)
Prevacid (generic: lansoprazole)

Procedure

The procedure takes about one hour from start to finish. While you are seated in a chair or lying on your side, thin soft tubing is gently passed through the nose, or occasionally the mouth. Upon swallowing, the tip of the tube enters the esophagus and the technician then quickly passes it down to the desired level. There is usually some slight gagging at this point, but it is easily controlled by following instructions. During the exam, the technician usually asks the patient to swallow saliva (called a dry swallow) or water (called a wet swallow). Pressure recordings are made and the tubing is withdrawn. Patients can usually resume regular activity, eating, and medicines immediately after the exam.