What Is Oesophageal Physiology Testing?

Manometry of Oesophagus

Oesophageal manometry is a test to measure how well the esophagus is working. This test assesses the movements of the oesophagus, the tightness of the sphincters on both ends of the oesophagus and the presence of hiatus hernia.

High-resolution manometry (HRM) is the latest technology in manometry and is considered as the gold standard for measuring movements of oesopahus. How to Effectively Use High-Resolution Esophageal Manometry?

What Is Oesophagus (Gullet)?

The Oesophagus (British English), Esophagus (American English) or commonly known as the food pipe or Gullet. The oesophagus is a muscular tube connecting the throat with the stomach. The esophagus is about 25 cm long. The esophagus travels behind the windpipe (trachea) and heart, and in front of the spine. To connect to the stomach, the esophagus passes through the diaphragm.

Both ends of the oesophagus are tightly closed by sphincters at all times except for the time we swallow, vomit or belch. They keep food, stomach acid, and secretions from going down the windpipe or causing inflammation in the oesophagus. Traveling acid and stomach contents to the oesophagus is called reflux.  Diseases of the oesophagus may cause difficulty swallowing (dysphagia), painful swallowing or oesophagitis, heartburn, regurgitation, chest pain, or cause no symptoms at all.

What Is Oesophageal Physiology Testing?

The most common types of oesophageal physiology testing are manometry and ambulatory 24-hour reflux monitoring.

Why These Tests Are Performed

The tests may be ordered when:

  • There are symptoms of reflux disease such as heartburn, regurgitation or nausea after eating (gastroesophageal reflux disease, or GORD)
  • Underlying GORD is suspected such as chronic cough, recurrent chest infection, hoarse voice, dental erosion.

Problems swallowing (feeling like food is stuck behind the breast bone), chest pain which is not due to heart conditions

 

 

How the test is performed?

During esophageal manometry, a thin pressure-sensitive tube is passed through the nose, down the oesophagus, and into the top of the stomach. Before the procedure, the patient can receive numbing medicine inside the nose and throat. This helps make the insertion of the tube less uncomfortable.

After the tube is in the stomach the patient is given swallows of water and sometimes bread to measure muscle contractions. The tube is removed after the test is completed. The actual test can take as little as 15 minutes.

How Does The Test Will feel?

Passing a manometry tube through the nose is a strange experience with the sensation of a cold object traveling down the throat. It can be uncomfortable but not painful. The majority of patients feel minimal (or no) gagging sensation just during the few seconds that the tube is passing the throat. Also, there is some minor discomfort in the nose and throat during the test.

An example of a high-resolution manometry recording in relation to the anatomy of the oesophagus:

Gastro-oesophageal Reflux Monitoring

24 hour ambulatory pH and Impedance Monitoring:

Performed after manometry in patients with suspected reflux disease, pH and impedance monitoring is a procedure that measures the level of acidity inside the oesophagus. In normal conditions, there is minimal acid in the oesophagus. Depending on the purpose of the test the patients may be advised to stop acid medications before the test.

How the test is performed?

A very thin (2mm in diameter) acid-sensitive catheter is placed in the oesophagus whilst the nose is still numb after manometry. This catheter is attached to a small device that records changes in oesophageal pH over 24 hours. Within the same catheter, there are sensors that measure impedance which significantly increases the accuracy of reflux monitoring as well as providing further information on non-acid reflux, types of belching and amount of acid in the stomach.

The patient goes home with the monitor and is advised to continue with their normal daily activities and diet, returning the following day to have the probe removed. Insertion and removal take only 5-10 minutes.

How Does The Test Will feel?

A passing reflux tube is much easier than manometry and feels often as tickling the nose. Gaging with this tube is very rare and the test is very well tolerated in the majority of times. Initially, the tube is slightly sensed in the back of the throat by in a few minutes body temperature makes the plastic tube softer and sensation will settle further. During eating or drinking sometimes it is felt that the tube is being pulled into the oesophagus but of course the tube is fixed on the side of the face with a transparent tape that will not move. Taking a bath or shower during this test is not permitted and driving can be dangerous. Some patients are concerned that what happens if they cannot tolerate the tube at home. They will be trained on how to easily remove the tube if required. All our patients are also provided with a phone number to contact 24/7 if they need any assistance.

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