Esophageal Manometry-What to Expect and Preparation

 

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Judy J. Davis, M.D., F.A.A.P.

1095 E Warner Ave #102

Fresno, CA 93710

(559) 412-8184 Fax (559) 4381174





ESOPHAGEAL MANOMETRY


The esophagus is a tube that carries food and liquid from the throat to the stomach. The walls of the esophagus contain muscles that automatically contract whenever a person swallows. The contractions occur as a sweeping wave from the throat down the esophagus to push food into the stomach.


An important part of the esophagus is the muscle between the stomach and the end of the esophagus called the lower esophageal sphincter. This muscle opens only when food is swallowed and opens into the stomach or when a person burps or vomits. This muscle protects the lower esophagus from being injured from stomach acid and bile coming from the stomach. If this muscle does not close properly, it can cause the discomfort of heartburn and in time can lead to inflammation and scarring of the esophagus.


Manometry is a procedure, which records the pressure within an organ. Esophageal manometry measures the pressure of the esophagus and the lower esophageal sphincter. This procedure can evaluate the peristaltic waves that push food down the esophagus into the stomach as well as the lower esophageal sphincter.


EQUIPMENT USED DURING THE EXAMINATION:

The equipment consists of thin tubing with pressure sensors and openings at various locations. The tube is placed into the child's nose and advanced into the esophagus and stomach. When the esophagus and stomach squeeze against it, the pressure is recorded on a graph. The physician can evaluate these wave patterns to determine if they are normal or abnormal and whether the esophagus and lower esophageal sphincter are functioning normally.


WHY THE EXAM MAY BE REQUIRED:

There are a number of reasons why this procedure is done. Some children have difficulty swallowing food or liquid while others have choking episodes with gagging or vomiting. Other children have the feeling that food is getting stuck in their esophagus. This test is done to evaluate the function of the esophagus and the lower esophageal sphincter and also the location of the lower esophageal sphincter. The function of the upper esophageal sphincter can also be determined. This procedure is often done before and after medical or surgical treatment of the esophagus.


PREPARATION:

The child should not have food or liquid for four hours prior to the examination. Certain medications should not be taken at this time. The following medications have an effect on the contractions of the esophagus and should be held for 5 days prior to the procedure:


Reglan (metoclopramide),Urecholine (bethanechol), Donnatal, Levsin, Zantac (ranitidine), Axid (nizatidine), Valium, Librax, Tagamet (cimetidine), Pepcid (famotidine), Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Protonix (pantaprazole), AcipHex (rabeprazole), Kapidex.


THE PROCEDURE:

The procedure takes about 10  to 15 minutes to perform. While lying down, a thin tube is gently passed through the nose and the child will be asked to swallow as the tip of the tube enters the esophagus. The tube is gently advanced to the desired level. The child may gag or cough or vomit, but by following instructions this can be well controlled. During the examination the child may be asked to swallow again in order to determine the function of the esophagus and lower esophageal sphincter. Pressure recordings are made as the tube is slowly withdrawn. The child can resume regular activity, eating and medications immediately following the exam.


RESULTS:

Your doctor will be able to tell you the results of the esophageal manometry immediately following the test or the next day. If you have any questions regarding this procedure, please call (559) 412-8184.


Judy J. Davis, M.D., F.A.A.P.

Fellow American Academy of Pediatrics

Fellow SubBoard American Academy of Pediatric Gastroenterology

American Board of Nutrition

Clinical Professor, Department of Pediatrics, University of California, San Francisco


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