Atrium Health Navicent Gastroenterology & Hepatology

Esophageal manometry

Gastrointestinal problems can be difficult to diagnose and may require extensive procedures and laboratory testing. When considering the source of gastrointestinal distress, all aspects of the gastrointestinal system must be investigated thoroughly. This includes the esophagus, which connects the oral cavity to the stomach. Esophageal manometry is a procedure that is used to determine if the esophagus is properly constricting and relaxing during the process of swallowing.

Abnormalities in the muscular structure of the esophagus or the sphincter, which separates the esophagus from the stomach, can cause many uncomfortable symptoms; pain when swallowing, difficulty swallowing, heartburn and nausea after eating can all occur when there are esophageal defects. Chest pain and a feeling of food stuck in the area of the breastbone are also common signs that something is wrong in the esophagus. These symptoms are often misdiagnosed as gastroesophageal reflux disease (GERD), but prolonged difficulties should always be inspected more to determine the best course of treatment.

First steps in preparing for this procedure is to have an understanding how the procedure is performed and what the results provide your medical professionals. An esophageal manometry involves a thin, pressure-sensitive tube being inserted into the nostrils, through the esophagus and down to the stomach. This tube is then used to measure the pressure of muscle contractions in the esophagus as you swallow. If you are feeling a high level of anxiety, this can result in abnormal muscle constriction and relaxation, and though it may be minor, this can alter the results of the test.

Preparation

Preparing for esophageal manometry involves fasting for a minimum of 8 hours prior to having the procedure performed. It is necessary to fast from food and water, as anything present in the gastrointestinal tract could affect results. As with any medical procedure, it is important to disclose your full medical history to the doctor performing the esophageal manometry. The doctor should be aware of any prescribed or over the counter medications you are taking before the test, as some medications may need to be temporarily discontinued until after the procedure is finished. On the day of the test, it is vital to discuss any recent changes in symptoms since a physician last examined you.

Procedure

The procedure itself takes between thirty minutes and one hour to complete, so it is necessary to feel comfortable with your doctor and what facility the test is being performed in. At the beginning of the test, a nurse applies a numbing cream to the inside of your nostrils to prevent irritation from occurring. This cream also prevents you from sneezing or wrinkling your nose, which can adjust the pressure readings of the tube during the test.

During esophageal manometry, the tube used to measure pressure in the esophagus is long, thin, and flexible. The pressure-sensitive tube is lubricated well and inserted into the nose, through the esophagus and past the cardiac sphincter, which separates the esophagus from the stomach. While the tube is being passed, you will be asked to swallow small sips of water to begin the measurement processes of the test. It is common to experience mild gagging during this process.

This esophageal testing can be performed while you are upright or reclining, and to ensure that the best results are recorded, it is important to remain quiet, calm, and relaxed. During the test, swallowing should only occur under the instruction of the person performing the test, as this action will alter the results. The tube's presence does not typically cause pain, though it may cause mild discomfort for individuals that are more sensitive.

After the tube is inserted into your stomach, it is then pulled back slowly to sit just outside of the cardiac sphincter. At this time, the physician will instruct you to swallow and the pressure-sensitive tube will begin taking frequent readings that measure the strength and contractility of the esophageal musculature. If indicated, other tests may be performed while the tube is still present when the esophageal manometry procedure has been completed. Once all testing is finished, the tube is removed completely.

Risks

The risks of undergoing this procedure are uncommonly experienced, but these risks may include aspiration of fluid into the lungs, irregular heartbeats, and an esophageal perforation. Sore throats, nasal congestion, and nosebleeds are common side effects, which can present after this testing.

Outcome

Results of this testing are sent to your referring physician for review. Routinely results are normal, but abnormal results may indicate a motility problem in which the food is not propelled to the stomach at an appropriate rate or a weakened sphincter separating the esophagus from the stomach that can result is a painful backflow. Any abnormal results will be addressed immediately, and the testing will be repeated after an appropriate amount of time to determine if the problems are being corrected as desired.