What is Esophageal
Manometry?
Gastroenterologists perform esophageal
manometry to determine the strength
and function of a patient’s esophagus
and esophageal sphincter. It measures
pressures and muscle contraction patterns
in the patient’s esophagus.
Esophageal manometry is used to
evaluate patients who have difficulty
swallowing — keeping in mind that there
are numerous diseases of the esophagus
that cause people to have difficulty
swallowing and/or the sensation of having
food stuck in their throat.
Esophageal manometry is also used to
evaluate patients who have chest pain
that is related to their esophagus (i.e.,
not their heart), people who suffer from
heartburn or acid reflux and those who
are scheduled to have certain operations.
What roles do the esophagus and
sphincter play?
The esophagus is a tubular muscle that works
with gravity to push food into the stomach using
a highly coordinated series of muscle contractions.
The sphincter muscle is situated at the lower end
of the esophagus, and it remains closed until a person
swallows food or liquid
What is a 24-hour pH Monitoring
Impedance test?
Gastroenterologists perform 24-hour pH monitoring
and impedance tests to measure how much acid
(and non-acid) stomach content is fl owing backwards
or refl uxing into a patient’s esophagus. The doctor
uses this information to determine if the patient’s
heartburn, chest pain, cough or hoarse voice is related
to acid refl ux. Gastroenterologists also use this test to
investigate why a patient’s symptoms aren’t improving
while they are taking acid refl ux medicine.
How should patients prepare for
these tests?
An empty stomach will result in the safest and most
accurate examination, so patients should not eat
or drink anything for six hours before they have an
esophageal manometry or 24-hour pH monitoring and
impedance test.
Because a lot of medications a ect the esophageal
pressure and muscle contractions that are required
for swallowing — especially blood thinners or blood
pressure medications (i.e., calcium channel blockers),
nitrates and other drugs that a ect the gastrointestinal
tract such as narcotic pain medicine — patients
should let their gastroenterologist know about every
medication they are taking before they have one of
these tests.
Patients can take acid-lowering medications
before they have a 24-hour pH monitoring and
impedance test, but they should check with their
gastroenterologist fi rst to see if this is appropriate
for their test.
What happens during these tests?
Esophageal Manometry
The gastroenterologist or a member of the medical
team will use a cream or spray to numb the inside of the
patient’s nostrils. A thin, fl exible and lubricated catheter
(i.e., tube) is then passed through the patient’s nose and
into the stomach while he/she swallows sips of water.
The patient is seated or lying on his/her back while the
catheter is connected to a computer. This test typically
requires the patient to swallow liquids 10 times. Once
done, the catheter is gently removed. The procedure
normally takes about 30 minutes. Some patients
experience mild discomfort in their nose and/or throat
during the procedure.
In some instances, the gastroenterologist may
determine that the best approach is to sedate the
patient and pass the catheter through the mouth —
versus the nose — using an upper endoscopy, which
involves a small camera that’s housed in the
tip of a flexible tube.
24-hour pH Monitoring/Impedance
The patient’s nostrils are numbed using a cream or
spray to make it easier for the gastroenterologist or
a member of the team to pass a catheter through the
patient’s nose and into the esophagus as they take
sips of water. The tube is then taped to the patient’s
nose to ensure that the catheter remains in place.
The procedure normally takes 15 to 30 minutes to
complete. Once done, the patient is sent home and
asked to wear a small data recorder on the belt for the
next 24 hours. Patients can eat, drink and sleep as
normal during this period, although they will need to
keep a diary of their meals and activities and whether
they experience any refl ux episodes or symptoms.
The doctor or a member of the team will remove the
catheter, belt and data recorder the following day.
What happens once the catheter is removed?
Once the catheter is removed, the patient may
experience a mild sore throat or stu y nose. And while
it is rare, some patients have minor nosebleeds. The
good news is these conditions typically subside in
a few hours, and unless the gastroenterologist says
otherwise, the patient is free to resume their normal
routine, diet and medications as soon as the catheter
has been removed. The gastroenterologist will discuss
the test results with the patient within a few days.
Do these tests have risks or side effects?
Beyond the mild symptoms that can occur after the
catheter is removed, patients who have esophageal
manometry or 24-hour pH/impedance tests rarely have
serious side e ects. Patients can momentarily choke if
the tube accidentally shifts into the windpipe or airway.
In extremely rare cases, patients may experience
aspiration (i.e., when the stomach contents fl ow back
into the esophagus) or have a perforation (i.e., a tear
in the esophagus).
The key takeaway is that gastroenterologists always
take every precaution and will only recommend patients
have an esophageal manometry or 24-hour pH/
impedance test if they believe the benefi ts outweigh
the risks.
Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.