How does esophageal manometry work?

Question

What are the normal pressures when swallowing? When full?

Answer 1

The procedure takes about one hour from start to finish. While seated in a chair or lying on the side, thin soft tubing is gently passed through the nose, or occasionally the mouth. Upon swallowing, the tip of the tube enters the esophagus and the technician then quickly passes it down to the desired level. There is usually some slight gagging at this point, but it is easily controlled by following instructions. During the exam, the technician usually asks the patient to swallow saliva (called a dry swallow) or water (called a wet swallow). Pressure recordings are made and the tubing is withdrawn. Patients can usually resume regular activity, eating, and medicines immediately after the exam.

To a layperson, the contractile pattern of the esophagus looks like a chaotic, wiggling line. However, the tracing has very specific meanings depending on how the esophagus contracts and exerts pressure through the tube into the manometry machine.

A normal pattern may be seen where the esophagus has regular, sweeping contraction waves and excellent function of the valve at the end of the esophagus.

A common abnormal pattern results when the lower esophageal valve is weak and does not close properly. This allows food and acid to reflux up into the food pipe.

Another abnormal pattern occurs when the esophagus has lost its normal sweeping waves. 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 spasms 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.

Finally, there is a condition called achalasia in which the lower valve is very spastic and tight and the body of the esophagus has weak contractions.

So there are a variety of findings possible. The physician reviews these findings with the patient and explains what they mean.

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