Esophageal Manometry: Who Needs It and Why?

Our esophagus plays an important role in moving food from the mouth to the stomach through rhythmic muscular contractions known as peristalsis. However, sometimes these contractions do not function normally, leading to swallowing difficulties, chest pain, or reflux symptoms. Esophageal manometry is a specialized diagnostic test that helps assess how well the muscles and sphincters in your esophagus work. Let’s understand who needs this test and why it is important.

What is Esophageal Manometry?

Esophageal manometry is a method that measures the pressure and movement of the esophagus. During the test, a thin, flexible tube containing pressure sensors is passed through the nose into the esophagus and down to the stomach. The patient is asked to swallow small sips of water while the machine records the pressure generated by the esophageal muscles and the function of the lower esophageal sphincter (LES), which acts as a valve to control stomach acid from entering the esophagus.

Why is Esophageal Manometry Done?

This test is commonly recommended to:

Assess swallowing problems (Dysphagia): Patients experiencing difficulty swallowing solids, liquids, or both may have esophageal motility conditions such as achalasia or esophageal spasm. Manometry helps identify the exact cause.
Evaluate unexplained chest pain: Sometimes chest pain is not cardiac but arises from esophageal muscle spasms or disorders. Manometry helps differentiate esophageal causes from heart-related causes.
Before anti-reflux surgery (Fundoplication): For patients with severe GERD (Gastroesophageal Reflux Disease) needing surgical intervention, manometry assesses esophageal motility to decide the appropriate surgical approach.
Diagnose conditions like Achalasia: Achalasia is a condition where the LES fails to relax, causing food to get stuck in the esophagus. Manometry is the gold standard test to confirm this condition.
Evaluate ineffective esophageal motility (IEM): This condition involves weak peristaltic contractions, leading to poor clearance of food or refluxed acid, which contributes to GERD symptoms.
Pre-assessment for high-resolution pH impedance studies: Manometry helps locate the LES accurately before placing pH probes to measure acid exposure for GERD evaluation.

Who Should Undergo Esophageal Manometry?

Patients with Chronic Swallowing Difficulties: People who experience food sticking in the chest, choking, coughing while swallowing, or a feeling of blockage in the throat are primary candidates. Determining whether the problem lies in esophageal muscle weakness or nerve-related problems is crucial for proper treatment.
Patients with Non-Cardiac Chest Pain: When cardiac causes are ruled out, manometry helps identify if the pain arises from esophageal spasms, diffuse esophageal spasm (DES), or hypercontractile esophagus (jackhammer esophagus), where the esophagus contracts too forcefully.
Patients with Severe or Refractory GERD: In patients unresponsive to medications or those planned for surgical treatment, manometry evaluates esophageal movement to ensure the esophagus can effectively push food into the stomach post-surgery.
Pre-Operative Evaluation for Bariatric Surgery: Before certain weight loss surgeries like gastric bypass or sleeve gastrectomy, assessing esophageal motility helps predict complications like worsening reflux or swallowing difficulties post-surgery.
Suspected Achalasia Patients: Patients with progressive difficulty swallowing both liquids and solids, regurgitation of undigested food, or substantial weight loss should undergo manometry to confirm achalasia before proceeding with treatment options like pneumatic dilation, Botox injection, or POEM (Peroral Endoscopic Myotomy).

What Happens During the Test?

Preparation: Patients are asked to fast for at least 6 hours prior to the procedure.
Procedure: A numbing gel is applied in the nostril, and the catheter is gently inserted. The method takes approximately 20-30 minutes. Patients swallow small sips of water at intervals while pressures are recorded.
Discomfort: Minimal discomfort is experienced during tube insertion, but the procedure is safe and well-tolerated.
Results: The test results are interpreted by gastrophysiologists in Pune, like Dr. Rupali Bandgar-Jankar, who specialize in gastrointestinal motility conditions. Findings guide further management or surgical planning.

What Conditions Can Esophageal Manometry Diagnose?

Achalasia
Diffuse esophageal spasm
Hypercontractile (jackhammer) esophagus
Ineffective esophageal motility
Hypotensive LES (weak LES causing reflux)
Hypertensive LES (tight LES causing swallowing difficulty)

Why is Early Diagnosis Important?

Untreated esophageal motility disorders can lead to:

Severe malnutrition due to the inability to swallow food correctly
Aspiration pneumonia from regurgitated food entering the lungs
Chronic chest pain and discomfort are impacting quality of life
Esophageal dilation or damage in long-standing achalasia
Failure of anti-reflux surgeries if underlying motility issues are not assessed preoperatively

Early diagnosis allows targeted treatments like pneumatic dilation, surgical myotomy, Botox injections, or tailored medical therapy to enhance symptoms and prevent complications.

Conclusion:

Esophageal manometry is a vital diagnostic tool for assessing esophageal muscle and sphincter function. It is especially helpful for patients with unexplained swallowing difficulties, non-cardiac chest pain, or those requiring surgical treatment for GERD or achalasia. At Kaizen Gastro Care, Pune, Dr. Rupali Bandgar-Jankar provides expert assessment and interpretation of esophageal manometry results. Her specialized training in gastrointestinal motility ensures proper diagnosis and effective treatment plans for patients suffering from complex esophageal disorders.

If you have persistent swallowing difficulties, chest pain, or reflux symptoms unresponsive to treatment, consult with Dr. Rupali Bandgar-Jankar for a detailed evaluation. Early diagnosis is the key to a better quality of life.