Esophageal manometry

Esophageal manometry is a test that helps us evaluate the esophageal motility, presenting the pressures of the upper and lower sphincters and the contractions of the esophagus while swallowing.

As a result, it is a useful method for investigating:

1. Cases of chest pain when all other causes have been ruled out.
2. Any difficulty or pain while swallowing after upper endoscopy has ruled out any lesions of the mucosa. In these cases, we wish to detect any potential pathology concerning the esophageal muscle contractions that move food along.
3. In addition, the test should always be carried out before anti-reflux surgery for the treatment of gastroesophageal reflux disease (GERD) and perhaps before some bariatric surgery procedures. It is also useful for the evaluation of the esophageal motility after such operations, when necessary.

For the conventional technique, water-perfused catheters, bearing 8 smaller flexible tubes are used. The new high-resolution technique (High Resolution Manometry, HRM) used by our center is carried out by inserting a catheter containing 36 – 40 sensors and thus allowing for a better and more detailed analysis of the esophageal motility. As a result, it is now possible to identify disorders that were not fully determined in the past by the conventional method.

Preparing for the exam:

The patient is instructed not to drink or eat for 4-6 hours before the test (it may be for a longer period, depending on the suspected motility disorder).

In addition, any medical treatment that may affect the esophageal motility should be discontinued, that is:

1. Calcium channel blockers, nitrates, anticholinergics, prokinetics, theophylline, adrenergic agonists and antagonists and opioids should be stopped 24 hours before the test.
2. Benzodiazepines, barbiturates, antidepressants and neuroleptic agents should be stopped 12 hours before the test.

How is the manometry performed?

A thin and flexible catheter is passed through the nose down to the esophagus after local anesthesia has been administered. The presence of the catheter may cause a discomfort in the nose that will soon subside. After the catheter is fitted, its position is confirmed, and the patient is asked to breathe calmly for about 30 seconds. The measurements are then carried out during 10 sips of a small quantity of water with intervals of about 30 seconds between two successive sips. Depending on how well the patient cooperates, the test can take up to a maximum of 10 minutes. The catheter is then withdrawn, and the patient returns to his daily activities without any restriction.

The data is presented by the computer software in three dimensions and various parameters are calculated, which are then evaluated based on the “Chicago Classification”. This helps us distinguish the various disorders of esophageal motility, such as achalasia, which is further classified into subtypes, each having a different prognosis and requiring a different therapeutic approach. In addition, we can distinguish other rare conditions that we could not detect by reliable means in the past, such as the diffuse esophageal spasmand the jackhammer esophagus. Moreover, we can detect other disorders of the esophageal motility related to systemic diseases, such as scleroderma.

The test is safe, painless and well tolerated by the patient. The results are processed immediately and are given to the patient before leaving the hospital.