Oesophageal Manometry & 24 hr pH/Imp
Oesophageal manometry (also called oesophageal motility) is a procedure to measure the strength and function of your oesophagus and provides information about how the muscles in your throat and oesophagus work as food and liquids pass from the mouth to the stomach. Oesophageal manometry is performed for the following reasons:
- To evaluate the cause of reflux (regurgitation) of stomach acid and other contents back up into the oesophagus (gastro-oesophageal reflux disease or GORD).
- To determine what the cause is of difficulty with swallowing food.
- To determine the cause of non-cardiac chest pain.
Our oesophageal manometry probe is the smallest and most sophisticated on the market. This ensures we can perform the test to the highest standards whilst making the whole procedure as quick and comfortable as possible.
- What can be learned from the Oesophageal Manometry Test?
- The Procedure
- Gastro-Oesophageal Reflux monitoring
- How it feels
- Side Effects
- Preparation & Medications
What can be learned from the Oesophageal Manometry Test?
The most common use for oesophageal manometry is to evaluate the lower oesophageal sphincter in patients who have gastro-oesophageal reflux disease (GORD).
Manometry often can identify weakness in the lower oesophageal sphincter that allows stomach acid and contents to back up into the oesophagus.
Manometry can diagnose several oesophageal conditions that result in food sticking after it is swallowed. For example, achalasia is a condition in which the muscle of the lower oesophageal sphincter does not relax with each swallow. As a result, food is trapped within the oesophagus. Manometry reveals an absence of the waves and the contraction of the muscle everywhere in the oesophagus at the same time.
Abnormal function of the body of the oesophagus may result in food getting stuck. In patients with scleroderma the waves of muscular contractions fail to occur. With oesophageal spasm the entire oesophageal muscle may contract at one time which can cause discomfort, pain and obstruct food passage.
The procedure takes about 45 minutes from start to finish.
The nurse will verify that you had nothing by mouth in the last 6 hours prior to the test.
Your nostril and throat is numbed with a topical anaesthetic while you are sitting upright.
A thin flexible tube about 4mm (approximately the width of a pencil) is then passed through the nostril, down the back of the throat into the oesophagus and the stomach, while the patient swallows water. The tube has holes in it that sense pressure along the oesophagus. It will be positioned so that the pressure sensors cover the entire length of the oesophagus.
With the tube inside the oesophagus, you will lie down in a comfortable position.
You will be given small sips of water during the test to record the progression of the swallow.
The contractions of the oesophageal muscle will be measured at rest and during swallows.
Pressure recordings are made over about ten minutes and this tube is removed.
The results of the manometry test are displayed as a graph with a wave pattern that can be interpreted to determine if the oesophagus is functioning normally.
We also measure impedance which allows us to detect the movement of liquid and gas which may be swallowed or refluxed from the stomach. This tell us whether your swallows are effective or not.
Gastro-Oesophageal Reflux monitoring
24 hour ambulatory pH and Impedance Monitoring:
A second part of the test is pH and impedance monitoring. which is a procedure in which the pH (or level of acidity) is recorded for a prolonged period.
An acid-sensitive catheter is placed in the oesophagus and is attached to a small monitoring device that records changes in oesophageal pH over an extended period of time (up to 24 hours).
It provides information on the severity and pattern of reflux.
The information is helpful both to confirm the impression of reflux and to tailor therapy for the individual patient. The impedance measurement detects the direction of liquid flow so we can determine whether the acid sensed by the probe has come from the stomach or has been swallowed. The pH and Impedance probe is very small (2mm in diameter) and you can go home with it in place and continue with your normal daily activities, returning the following day to have the probe removed, which takes only 5-10 minutes.
How it feels
When the tube goes through your nose or mouth into your oesophagus, you may feel like coughing or gagging. The test may be easier if you try to take slow, deep breaths. You may not like the taste of the lubricant on the tube. After the test is over, your throat may feel a little irritable. However, this should improve within a few hours or so.
The procedure is not really painful because the nostril and throat is anesthetized, but it may feel slightly uncomfortable.
Once the tube is in place patients talk and breathe normally.
The side effects of oesophageal manometry are minor and include mild sore throat, rare nose bleed and, very uncommon sinus problems due to irritation and blockage of the ducts leading from the sinuses and into the nose.
You may experience some temporary discomfort in your throat. Over the counter throat lozenges may give some relief.
Occasionally, during insertion, the tube may enter the larynx (voice box) and cause choking. When this happens, the problem usually is recognized immediately, and the tube is rapidly removed.
Preparation & Medications
You should not eat for up to 6-12-hours before the test but you can drink water up until the start of the study.
Clothing – As you will be going home with the pH probe in place wearing certain clothes will make your life easier when getting changed. Try to wear trousers / skirts and loose tops / t-shirts. Dresses and Tunics should be avoided if possible.
If you have any queries or problems, please call Dr Anthony Hobson on 07850 114966.
You will be advised about which medications you should stop before the test.