Esophageal Manometry in Malvern, PA
The esophagus is the tube that carries food and liquid from the throat to the stomach. The wall of the esophagus contains muscle that rhythmically contracts when we swallow. This contraction (peristalsis) is a sweeping wave that carries food down the esophagus.
Another important part of the esophagus is the lower esophageal sphincter. This is a specialized muscle at the lower end of the esophagus at the junction of the esophagus and stomach that remains closed most of the time, only opening when swallowed material is moved down the esophagus or when one belches or vomits. The lower esophageal sphincter protects the esophagus from stomach acid and bile, which in turn can cause heartburn and damage to the esophagus.
Manometry is the recording of muscle pressures within an organ and esophageal manometry measures the pressure within the esophagus. It can evaluate the contractions of the esophagus in the main portion of the esophagus as well as the lower esophageal sphincter at the lower end of the esophagus.
The equipment 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 contracts on the tube, these pressures are transmitted to a computer analyzer that records the pressure changes. The physician can evaluate these wave patterns to determine if they are normal.
Reasons for the Exam
There are a number of symptoms that originate in the esophagus, including difficulty swallowing, heartburn, and chest pain. In addition, an x-ray or endoscopy may show abnormalities requiring further study by manometry. The exam is often done before or after medical or surgical treatment of the esophagus.
The preparation for esophageal manometry is simple. The patient should not eat or drink for at least eight hours before the examination. The physician will want to examine the esophagus in its natural state, that is without any medication that can affect the function of the esophagus. The physician informs the patient what medication should and should not be taken. Check with your physician about all your medications before this test.
The procedure takes about one hour. While seated, a thin soft tubing is passed through the nose. Upon swallowing, the tip of the tube enters the esophagus and the nurse or technician quickly passes the tub down to the desired level. There is usually some slight gagging at this point, but it is easily controlled by following instructions. The examination itself is usually performed lying down. During the examination, you will be asked to swallow small amounts of water. Pressure recordings are made and the tube is withdrawn. Patient can usually resume normal activity immediately after the examination.
The contraction pattern of the esophagus looks like a chaotic wiggling line. However, the contraction pattern has very specific meanings depending on how the esophagus contracts and exerts pressure through the tube into the recording apparatus.
- A normal pattern may occur where the main body of the esophagus has regular, sweeping contraction waves and excellent function of the lower esophageal sphincter.
- A common abnormal pattern occurs when the lower esophageal sphincter is weak and does not close properly. This allows food and acid to reflux up into the esophagus.
- Another abnormal pattern is seen when the esophagus has lost its normal contractions. This condition is called dysmotility, and it means that there are ineffective, weak or disorganized contractions. This pattern is often seen in older individuals.
- Intense esophageal spasm may be found where severe pain originates in the esophagus. This pattern shows very intense contractions throughout the esophagus and may be accompanied by pain.
- There is an uncommon condition called achalasia in which the lower esophageal sphincter is very spastic and contractions in the body of the esophagus are weak.
- There are a variety of findings and the physician reviews these findings with the patient and explains their significance.
The primary benefit to the physician is clear documentation of the muscle function of the esophagus. With this information, a specific treatment program can be outlined or reassurance provided if the exam is normal.
Alternatives to Manometry
Nothing really takes the place of manometry. Other techniques used to study the esophagus include upper GI series and using barium swallow, endoscopy, and 24-hour monitoring of the esophagus to measure acidity as it refluxes from the stomach.
Side Effects and Complications
There are usually no serious problems associated with manometry. Slight gagging is normal during the exam and a minimal sore throat may be present afterwards.