People who suffer from reflux, swallowing problems or regurgitation symptoms, where the stomach contents backflow into the oesophagus (food pipe), might have a problem with their oesophageal motility. Usually, when a person swallows, the oesophagus contracts along its length, opening the lower oesophageal sphincter (LOS).
The LOS acts as a barrier between the stomach and the oesophagus. It prevents the stomach contents from moving into the oesophagus. However, in some people, it can become ineffective, either contracting too much or not enough.
Oesophageal manometry measures the pressure inside the oesophagus during contraction, detecting any problems. It’s the gold standard for evaluating oesophageal motility issues.
In this guide:
- What is an Oesophageal Manometry Test?
- Who Needs Oesophageal Manometry?
- How Does Oesophageal Manometry Work?
- Preparing for Oesophageal Manometry
- What to Expect
What is an Oesophageal Manometry Test?
Oesophageal manometry involves inserting a catheter via the nose into the oesophagus. This catheter contains pressure sensors spaced evenly along its length to detect changes in pressure. The more sensors that are available, the greater the resolution. There can be up to 36 pressure sensors.
Much of the focus is on the lower oesophageal sphincter (LOS). The LOS can either contract too much or not enough, helping to narrow down the underlying condition.
Who Needs Oesophageal Manometry?
Your doctor might recommend oesophageal motility testing if they suspect a motility issue with your oesophagus or LOS. Symptoms that might require further testing include:
- Chest pain
- Heartburn
- Acid reflux
- Pain or difficulty swallowing
- Feeling that food gets stuck in your chest
- Nausea after eating
Oesophageal manometry is a useful test to determine the underlying cause behind your symptoms. Potential conditions include:
- Achalasia occurs when the LOS fails to relax after swallowing, preventing food from entering the stomach, in addition to an absence of motility in the food pipe. Common symptoms include regurgitation, discomfort, and difficulty swallowing.
- Diffuse oesophageal spasms involve random involuntary contractions of the oesophageal muscles, which are forceful and out of sync with each other. Patients might complain of chest pain or difficulty swallowing.
- Scleroderma is a progressive condition of the connective tissue that prevents the LOS from moving. It can lead to severe gastroesophageal reflux disease (GORD).
- Hypertensive lower oesophageal sphincter is a condition where the pressure in the LES is abnormally high, potentially causing discomfort and pain.
- Ineffective oesophageal motility (IOM) is a condition characterised by weak contractions in the oesophagus during swallowing, which is ineffective at pushing food toward the stomach.
- Nutcracker oesophagus involves highly intensified oesophageal contractions that are excessively strong and prolonged, often resulting in pain.
How Does Oesophageal Manometry Work?
Oesophageal motility testing involves inserting a pressure monitor into the oesophagus. The monitor contains pressure sensors designed to measure changes in pressure along the full length of the oesophagus. The patient will swallow small sips of water during the procedure or may eat a test meal. The probe detects these pressure changes and software converts the data into a topographical pressure map. This is also known as oesophageal pressure topography or OPT.
Alternatively, the focus can be entirely on the LOS. In this case, the pressure monitor will display the pressure changes as a trace, showing when it is and isn’t contracting. Prolonged or insufficient contraction is often diagnostic for the underlying condition.
Preparing for Oesophageal Manometry
You will not be able to eat or drink for several hours before the procedure. Your doctor will advise on the correct fasting time, but it can range from six hours to overnight.
You might also have to discontinue your current medications or supplements. Medications that can interfere with the test results include:
- Calcium channel blockers
- Nitrates
- Opioids
- Sedatives
- Antacids
People with diabetes cannot have breakfast before the procedure. Speak to your doctor about altering your medication to ensure your blood sugar levels remain healthy.
What to Expect
Oesophageal manometry is performed as an outpatient procedure. You will be able to return home the same day – it usually takes around 30 minutes. You will not be given any general anaesthetic and will be awake for the procedure.
You can expect:
- Your nose and throat are numbed. The doctor will offer either a numbing spray or gel to numb your nose and throat.
- The catheter is passed through your nose. It will not interfere with your breathing. However, you might feel some minor discomfort.
- You will sit either upright or be asked to lie flat on a table.
- You will swallow small sips of water. This will trigger the oesophageal contraction, which is detected by the catheter. The procedure will continue until all the information is gathered.
- It is best to try to stay relaxed. Take slow, deep breaths to remain calm during the procedure. It can feel slightly uncomfortable but is not painful.
- The catheter is removed. After all the information is collected, you can return home safely. You might want someone to be there to pick you up.
Potential Risks
Oesophageal motility testing is a safe and common procedure. You might experience some minor discomfort during the procedure, such as watery eyes, gagging, or irritation in your nose and throat. It’s common to experience some minor side effects, including:
- Sore throat
- Stuffy nose
- Minor nosebleed (very rare)
If your nose bleeding persists for several hours, seek medical attention. This is not a normal side effect of the procedure.
Reflux testing isn’t just about measuring oesophageal motility. It can also involve detecting changes in pH levels in the oesophagus over 24 hours. This test for acid reflux is the gold standard, providing a reliable diagnosis for GORD. Want to know more? See our 24-hour reflux testing page for further details.