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What is an
Esophageal Manometry?
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.
What
equipment is used for this test?
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.
What are
the reasons for this test?
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.
Is there a
prep for this test?
The
preparation for esophageal manometry is simple. The patient should not eat or
drink anything after midnight. The physician will want to examine the
esophagus in its natural state, which 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.
What
does the test entail?
The procedure
takes about one hour. While seated, 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.
What will
the results show?
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.
Are there
any benefits in having this test performed?
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.
What are
the 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.
Are there
any side effects or 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.
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