Esophageal Manometry Test

What is an esophageal manometry test?

An esophageal manometry test is a study of your esophageal motility (motor function). Your esophagus is the muscular swallowing tube that connects your mouth to your stomach. Muscles in your esophagus move food down to your stomach when you swallow and keep it from coming back up. But certain esophageal disorders can interfere with this process, causing swallowing problems and reflux.

Why would you need an esophageal manometry test?

A healthcare provider might want to check your esophageal motility if you’ve been having issues related to swallowing or keeping food and other substances down in your stomach. If you’re having a manometry test, it’s likely you’ve already had an imaging test to look for structural problems in your esophagus. If imaging can’t explain your symptoms, motility testing might be the next step.

Possible symptoms of esophageal motility disorders include:

• Difficult or painful swallowing.
• Food coming back up (regurgitation).
• Chronic acid reflux that doesn’t respond to medication.
• Heartburn or noncardiac chest pain.

What can esophageal manometry detect?

Manometry is a measurement of pressure, using a pressure-sensing device called a manometer. It detects the pressure that different muscles produce when they activate. An esophageal manometry test measures two types of muscle activity in your esophagus. It measures the movements that carry food downward (peristalsis) and how the valves at the top and bottom of your esophagus open and close.

Abnormal pressure in these muscles might help explain your symptoms and diagnose certain conditions, including:

• Achalasia.
• Scleroderma.
• Esophageal spasms.
• Rumination syndrome.

How does esophageal manometry work?

High-resolution manometry (HRM) works by placing a catheter plotted with high-resolution pressure sensors inside your esophagus. Up to 36 sensors, spaced 1 centimeter apart, span your esophagus and measure your muscle contractions when you swallow. They transmit their data to a computer, which converts it into a topographical pressure map (esophageal pressure topography, or EPT).

How should I prepare for the esophageal manometry procedure?

You’ll need to avoid eating or drinking within the six hours before the test. Your healthcare provider may also ask you to discontinue certain medications 24 hours before the test, including:

• Calcium channel blockers.
• Nitrates.
• Opioids.
• Sedatives.

Are you sedated for esophageal manometry? Does it hurt?

You typically won’t be sedated, though you can discuss sedation with your healthcare provider in advance if you’re very anxious about the test. Esophageal manometry shouldn’t be painful, although you may find the catheter in your esophagus to be a little uncomfortable. You’ll have topical anesthesia to help numb your throat to minimize this discomfort. Your throat might feel a little sore afterward.

How is the esophageal manometry test done?

To set up the test, a healthcare provider will need to place the catheter with the sensors on it inside your esophagus. They do this by passing it through your nasal cavity and down through your esophagus until it reaches your stomach. Before placing the catheter (nasogastric tube), they’ll lubricate the end and apply a topical anesthetic inside your nose and throat to reduce the discomfort from friction.

Once the tube’s in place, they’ll take a baseline reading while you lie on your back and breathe regularly. Then you’ll swallow some sips of water. For the standard test, you’ll swallow seven to 10 times while lying down or reclining. Your healthcare provider might test some different variations after that. For example, they might have you sit upright, or swallow something thick, like applesauce.

What are the possible risks or complications of the procedure?

You might feel like coughing, choking or gagging when the catheter is being placed, but this usually passes quickly. Some people have nosebleeds from the nasogastric tube, but this is uncommon.

How long does it take?

It shouldn’t take more than 15 minutes.