Oesophageal Manometry (Measuring Pressure in the Gullet)

Oesophageal manometry is a test that measures how the muscles of the gullet (the oesophagus) and the valve at the entrance to the stomach are working. It is used above all to look for the cause of difficulty in swallowing.

How is the test done?

A thin, flexible measuring catheter is passed through the nose into the gullet. You are asked to drink small sips of water at set intervals. Meanwhile the contractions of the gullet and the working of the valves are recorded by a computer.

The test usually takes 20–30 minutes. The time needed for preparation and placing the catheter can vary from person to person.

What should I pay attention to before the test?

You should usually go without food for at least 6 hours before the test. Some patients, particularly when achalasia is suspected, may need a longer fast or special preparation.

Tell your doctor about the medicines you take. Do not stop your medicines without asking your doctor.

Is the test painful?

Anaesthesia or putting the patient to sleep is usually not needed. A numbing gel may be applied to the nose. While the catheter is being placed there may be brief retching, or discomfort in the nose or throat.

Which conditions is it used to diagnose?

It is used above all to investigate achalasia, disorders of the gullet’s contractions and difficulty in swallowing that has no clear explanation. It may also be needed before reflux surgery.

Important: manometry does not measure stomach acid. To assess how much and how often acid refluxes, pH or pH-impedance monitoring is done.

Once the test is finished, patients can usually return to their daily life.

The oesophageal pH test

The oesophageal pH test measures how often acid refluxes from the stomach down into the lower gullet. For this procedure a thin, flexible plastic tube with a pH probe at its tip is passed through the nose towards the stomach, and the end of this probe is connected to a recording device worn on a belt at the waist. The reflux of acid from the stomach into the lower oesophagus is recorded over 24 hours. When the complaint of reflux begins, or when there is chest pain, a button on the recorder is pressed, and the relationship between the onset of the symptoms and the acid pH being measured is observed. The records are then gathered on a computer and analysed.

Surgery for reflux

Generally most patients respond well to changes of habit and to drugs. If the reflux is at a level that is very troublesome and began at an early age, surgical reconstruction of the lower oesophageal sphincter is considered as an alternative method of treatment. With the older kinds of surgery a stay of six weeks in hospital was in question. With this new procedure, called laparoscopic Nissen fundoplication, the stay in hospital and the time to recovery have become considerably shorter. The decision to operate will be made after examination, radiological investigation, oesophageal pH measurement and manometry.