What is Esophageal Manometry? Purpose, Levels/Procedure & Results

Esophageal manometry is a test that measures how well your esophagus works when you swallow. Think of it as a way to check the strength and coordination of the muscles in your food pipe. This gentle procedure helps doctors understand if your swallowing problems stem from muscle weakness, poor coordination, or other issues in your esophagus.

What is esophageal manometry?

Esophageal manometry measures the pressure and muscle movements in your esophagus. Your esophagus is the tube that carries food from your mouth to your stomach, and it needs to squeeze in a coordinated wave-like motion to push food down properly.

During the test, a thin, flexible tube with pressure sensors is gently placed through your nose and into your esophagus. These sensors detect how strong your esophageal muscles are and whether they're working together smoothly. The test takes about 30 minutes and provides valuable information about your swallowing function.

This procedure is also called esophageal motility testing because it specifically looks at how your esophagus moves food along. It's considered the gold standard for diagnosing swallowing disorders related to muscle function.

Why is esophageal manometry done?

Your doctor might recommend esophageal manometry if you're having trouble swallowing or experiencing chest pain that isn't heart-related. This test helps identify the root cause of your symptoms so you can get the right treatment.

The most common reason for this test is difficulty swallowing, which doctors call dysphagia. You might feel like food gets stuck in your chest, or you might have pain when swallowing. Some people also experience regurgitation, where food comes back up after swallowing.

Here are the main conditions this test can help diagnose:

• Achalasia - when the lower esophageal sphincter doesn't relax properly
• Esophageal spasms - irregular muscle contractions that can cause chest pain
• Scleroderma - an autoimmune condition that can weaken esophageal muscles
• Ineffective esophageal motility - when the muscle contractions are too weak
• Gastroesophageal reflux disease (GERD) - to evaluate if surgery might help

Your doctor might also order this test before certain surgeries to make sure your esophagus will function properly afterward. It's particularly important before anti-reflux surgery to ensure the procedure won't cause swallowing problems.

What is the procedure for esophageal manometry?

The esophageal manometry procedure is straightforward and typically takes 30 to 45 minutes. You'll be awake during the entire test, and while it may feel uncomfortable, it's generally well-tolerated by most people.

First, your healthcare team will explain the procedure and answer any questions you have. You'll be asked to sit upright in a chair or lie on your side. A numbing spray might be applied to your nose and throat to reduce discomfort during tube insertion.

The thin catheter, about the width of a piece of spaghetti, is gently inserted through your nose and guided down into your esophagus. This part can feel uncomfortable, but it usually only lasts a few seconds. Once the tube is in place, you'll be asked to swallow small amounts of water while the sensors record pressure measurements.

During the test, you might feel the urge to gag or cough, which is completely normal. The technician will guide you through each swallow and let you rest between measurements. You'll typically perform 10 swallows with small sips of water while the machine records your esophageal muscle activity.

After all measurements are complete, the catheter is quickly removed. Most people feel relief once the tube is out, though your throat might feel slightly scratchy for a short time afterward.

How to prepare for your esophageal manometry?

Preparing for esophageal manometry is simple, but following the instructions carefully helps ensure accurate results. Your doctor will provide specific guidelines, but here are the general preparation steps you can expect.

You'll need to stop eating and drinking for at least 8 hours before your test. This fasting period, similar to preparing for other medical procedures, ensures your esophagus is empty and the measurements are accurate. You can usually have your test in the morning and eat normally afterward.

Several medications can affect esophageal muscle function, so your doctor might ask you to temporarily stop certain drugs. These preparations help ensure the test shows how your esophagus naturally functions:

• Proton pump inhibitors (like omeprazole) - usually stopped 7 days before
• Calcium channel blockers - may need to be paused 48 hours before
• Nitrates - typically stopped 24 hours before the test
• Antispasmodic medications - usually discontinued 24 hours prior
• Sedatives or muscle relaxants - may need to be avoided

Never stop medications without talking to your doctor first. They'll work with you to safely manage your regular medications while preparing for the test. Some medications are too important to stop, and your doctor will weigh the benefits and risks.

Wear comfortable clothing and avoid heavy makeup or jewelry around your neck. Let your healthcare team know if you have any allergies or if you're pregnant, as these factors might affect the procedure.

How to read your esophageal manometry results?

Esophageal manometry results show the pressure patterns and muscle coordination in your esophagus. Your doctor will review these measurements to determine if your esophageal muscles are working normally or if there's a specific disorder affecting your swallowing.

Normal results typically show coordinated muscle contractions that effectively push food toward your stomach. The pressure waves should be strong enough to move food along, and the timing should be smooth and sequential from top to bottom.

Here's what different measurements tell your doctor about your esophageal function:

• Lower esophageal sphincter pressure - normally 10-45 mmHg when relaxed
• Esophageal body contractions - should be 30-180 mmHg in strength
• Coordination timing - contractions should progress smoothly downward
• Sphincter relaxation - should open completely when you swallow
• Residual pressure - should drop to very low levels during swallowing

Abnormal results might show weak contractions, uncoordinated muscle movements, or problems with sphincter function. Your doctor will explain what specific patterns mean for your condition and discuss appropriate treatment options based on your results.

The interpretation requires expertise, so your doctor will correlate the test results with your symptoms and medical history to make an accurate diagnosis. This comprehensive approach ensures you receive the most appropriate treatment plan.

What are the risk factors for abnormal esophageal manometry?

Several factors can increase your risk of having abnormal esophageal manometry results. Understanding these risk factors helps you and your doctor better interpret your test results and plan appropriate treatment.

Age is one of the most significant risk factors, as esophageal muscle function naturally changes over time. Older adults often experience weaker esophageal contractions and slower food transit, which can show up as abnormal patterns on manometry testing.

These conditions and factors commonly affect esophageal function and may lead to abnormal test results:

• Gastroesophageal reflux disease (GERD) - chronic acid exposure can damage muscles
• Autoimmune diseases like scleroderma - directly affect muscle tissue
• Diabetes - can damage the nerves that control esophageal muscles
• Previous chest surgery or radiation - may cause scar tissue formation
• Certain medications - particularly those affecting smooth muscle function
• Neurological conditions - can disrupt the signals controlling swallowing

Lifestyle factors can also contribute to esophageal dysfunction. Heavy alcohol use, smoking, and certain dietary habits may affect muscle coordination over time. Stress and anxiety can sometimes worsen swallowing symptoms, though they rarely cause primary esophageal disorders.

Having risk factors doesn't mean you'll definitely have abnormal results, but it helps your doctor understand the context of your symptoms and test findings.

What are the possible complications of abnormal esophageal manometry?

Abnormal esophageal manometry results often indicate underlying conditions that can lead to complications if left untreated. Understanding these potential complications helps you appreciate why proper diagnosis and treatment are important for your long-term health.

The most immediate concern is usually difficulty swallowing, which can affect your nutrition and quality of life. When food doesn't move properly through your esophagus, you might avoid certain foods or eat less, potentially leading to weight loss or nutritional deficiencies.

Here are the main complications that can develop from untreated esophageal motility disorders:

• Aspiration pneumonia - when food or liquid enters your lungs
• Malnutrition - from avoiding foods or eating less due to swallowing difficulties
• Esophageal dilation - enlargement of the esophagus from food backup
• Severe gastroesophageal reflux - when the lower sphincter doesn't function properly
• Esophagitis - inflammation from acid exposure or food irritation
• Barrett's esophagus - precancerous changes from chronic acid exposure

In rare cases, severe motility disorders can lead to more serious complications. Some people develop recurrent respiratory infections from aspiration, while others may experience significant weight loss that requires medical intervention.

The good news is that most complications are preventable with proper treatment. Your doctor can recommend therapies to improve esophageal function and reduce your risk of developing these problems.

When should I see a doctor for esophageal manometry?

You should consider seeing a doctor about esophageal manometry if you're experiencing persistent swallowing difficulties or unexplained chest pain. These symptoms can significantly impact your daily life and may indicate treatable conditions.

The most common reason to seek medical attention is difficulty swallowing that doesn't improve on its own. This might feel like food getting stuck in your chest, pain when swallowing, or needing to drink lots of water to get food down.

Contact your doctor if you're experiencing any of these symptoms that could indicate an esophageal motility disorder:

• Food consistently feels stuck in your chest or throat
• Chest pain that's not related to your heart
• Frequent regurgitation of undigested food
• Difficulty swallowing both solids and liquids
• Unintentional weight loss due to eating problems
• Recurring respiratory infections that might be from aspiration

You should seek immediate medical attention if you experience sudden, severe difficulty swallowing, chest pain with shortness of breath, or signs of aspiration like coughing up food or frequent lung infections.

Your primary care doctor can evaluate your symptoms and refer you to a gastroenterologist if needed. The specialist can determine whether esophageal manometry would be helpful in diagnosing your condition and planning treatment.