What Is an Esophageal Manometry Test?

Table of ContentsView AllTable of ContentsPurpose of TestRisks and ComplicationsBefore the TestDuring the TestAfter the TestInterpreting the ResultsFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Purpose of Test

Risks and Complications

Before the Test

During the Test

After the Test

Interpreting the Results

Frequently Asked Questions

Esophageal manometry, also known as an esophageal motility study, is a test used to diagnose problems involving the movement and function of youresophagus(the tube that runs from your throat to your stomach). The procedure involves the insertion of a pressure-sensitive tube into your nose that is then fed into your throat, esophagus, and, stomach.Esophageal manometry is used when you have a chronic reflux or swallowing problems that cannot be explained.

Verywell / Emily Roberts

what to expect during an esophageal manometry test

Esophageal manometry can help determine whether your problem is associated with the esophagus itself and, if so, in which part and to what degree. Specifically, it is used to detect esophageal motor dysfunction.This refers to problems involvingperistalsis(the involuntary, rhythmic contraction that helps propel food to the stomach) or the valves, calledsphincters, which open and close whenever you eat or drink.

The esophagus contains two such sphincters:

Indications

Esophageal manometry may be recommended if you havedysphagia(difficulty swallowing),odynophagia(painful swallowing), or symptoms of reflux that resist treatment (including heartburn and chest pain).

However, esophageal manometry is usually not the first test used to diagnose these conditions. Rather, it would be performed after X-rays and other tests have ruled out more likely causes, including esophageal obstruction,esophageal stricture,hiatal hernia, or heart disease.

Esophageal manometry may be used to help diagnose:

The test is not used to diagnosegastroesophageal reflux disease (GERD)but rather to characterize the nature of the disease.It may be recommended if you fail to respond to GERD therapy or ifanti-reflux surgeryis being considered.

Limitations

While manometry is useful in identifying motility problems, it does have its limitations. Given that spasms and swallowing problems are often transient, there is no guarantee they will occur during the test. This may lead to inconclusive or ambiguous results.

Because of this, many people with esophageal dysfunction will have normal motility parameters after testing.By contrast, abnormal findings may sometimes have no relation to the symptoms you’re experiencing. It is for this reason that expert consultation is needed if the findings are anything less than conclusive.

Alternative Tests

While a conventional esophageal manometry is the best method for assessing motility dysfunction, there are other tests that may be more appropriate for other conditions.Among them:

Laryngopharyngeal Reflux (LPR): A Guide to Silent Reflux

While the very thought of esophageal manometry may seem off-putting, it is a relatively safe procedure and usually nowhere near as uncomfortable as you might think.

Occasionally, during insertion, the tube may enter the larynx (voice box) and cause choking.

Complicationsare rare but may include:

An esophageal manometry does require some preparation on your part. While intubation (having a tube inserted into your throat) may seem awkward, every effort will be made to ensure that you are as comfortable and relaxed as possible.

Timing

The test itself takes around 15 to 30 minutes to perform. Barring delays, you should be in and out of the office within 60 to 90 minutes. Esophageal manometry is often performed in the morning to ensure your stomach is empty. It is best to arrive a half hour in advance to sign in and settle.

Location

What to Wear

It is best to wear a loose-fitting outfit. You won’t be asked to undress but will be provided a hospital gown to protect your clothes from water and gels used for the test.

Food and Drink

To avoid aspiration, you will be asked to stop eating or drinking anything, including water, four to six hours before the test. If this instruction is not followed, the healthcare provider may have to cancel and reschedule your appointment.

Medications

There are a number of medications that can affect the motility of your esophagus. Some need to be stopped to ensure they do not interfere with the testing.

To this end, always advise your healthcare provider about any drugs you are taking, whether they be pharmaceutical, over-the-counter, traditional, homeopathic, or recreational. The healthcare provider will be able to tell you which, if any, need to be stopped and for how long.

Among some of the classes of drugs that may be problematic:

Cost and Health Insurance

The test requires insurance pre-authorization, which your gastroenterologist can submit on your behalf. If approved, it is important to know what your co-pay and out-of-pocket expenses will be. If you cannot afford these costs, insured or not, speak to the gastroenterology administrator about a monthly repayment plan.

If you are denied coverage, ask your insurer for a written reason for the denial. You can then take the letter to your state insurance consumer protection office and ask for help. Your gastroenterologist should also intervene and provide additional motivation as needed.

Other Considerations

Sedatives are not used for an esophageal manometry test. As a result, you can usually drive yourself to and from the healthcare provider’s office without concern.

On the day of your test, after signing in and confirming your insurance information, you may be asked to sign a liability form stating that you understand the purpose and risks of the test. You would then be taken to an examination room.

Pre-Test

Upon entering, you will be provided a hospital gown and asked to sit on an examination table. You will need to remove your glasses and anything in your mouth that could be dislodged, such as a tongue piercing.

Sedatives are not used because they can over-relax the esophagus and interfere with the test results. A topical numbing agent may be used to help ease discomfort.

You will likely be given the choice of which nostril to use for the test. (The nasal route is preferred as it is less likely to cause gagging than the throat.)

Throughout the Test

Post-Test

Once completed, you will be given a tissue to blow your nose but otherwise will be well enough to return home. You can resume your normal diet and any medications you regularly take.

Side effects of esophageal manometry tend to be minor and may include a mild sore throat, coughing, minor nosebleeds, and sinus irritation.

If your throat is sore following an esophageal manometry test, you can either gargle with salt water or use a benzocaine throat lozenge like Cepacol. The irritation will usually go away in a day or so.

It is also not uncommon to have blocked sinuses and minor nosebleeds. You can often help clear sinuses with an over-the-counter corticosteroid nasal spray or a sterile saline nasal spray. Antihistamines don’t usually help since the swelling is due more to inflammation than allergy.

While serious side effects are uncommon, you should call your healthcare provider immediately if you experience any unusual symptoms, including fever, severe reflux, vomiting, arrhythmia, shortness of breath, or bloody sputum.

A few days after the test is performed, your healthcare provider will review the results with you. While the tests can provide valuable insights into how well your esophagus and sphincters are functioning, clinical judgment may be needed to interpret the results.

At times, the answers may not be so clear. Esophageal manometry is a technically challenging test prone to variables that can sway the results. While the tests may provide irrefutable evidence of a motility problem (such as dysphagia), other conditions (like achalasia) may be far more difficult to pin down. Clinical experience and expertise are, therefore, central to obtaining an accurate diagnosis.

If you are not fully convinced of what is being told you, do not hesitate to seek a second opinion. Sometimes a fresh set of eyes can add new insights and bring you that much closer to an effective treatment.

A Word From Verywell

If you are feeling nervous about undergoing an esophageal manometry, don’t wait until last minute to share these concerns with your healthcare provider or a member of the medical staff.

Sometimes it helps to be walked through the procedure and see what the catheter actually looks like. Knowing what to expect can relieve a lot of the fear.

Try to focus on the benefits and aims of the test. As a relatively fast and safe procedure, the benefits of esophageal manometry will almost always outweigh the downsides.

The esophageal manometry test is not typically needed todiagnose gastroesophageal reflux disease (GERD). However, if the condition doesn’t get better with treatment, manometry can identify any issues with the esophagus that might be contributing to the GERD.

An esophageal obstruction is when food, a foreign object, or an esophageal diverticulum causes partial or complete blockage in the esophagus. An esophageal diverticulum is a small pouch that can develop in weak areas of the esophageal lining.

19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yadlapati, R.; Gawron, A.; Keswani, R. et al.Identification of Quality Measures for Performance of and Interpretation of Data From Esophageal Manometry.Clin Gastroenterol Hepatol.2016;14:526-34. doi:10.1016/j.cgh.2015.10.006Sharma, N. and Freeman, J. (2012). “Chapter 8: Esophageal Manometry.“The Esophagus (5th Edition).Eds: Richter, J. and Castell, D. Hoboken, New Jersey: Blackwell Publishing. doi:10.1002/9781444346220Hershcovici T, Mashimo H, Fass R.The lower esophageal sphincter.Neurogastroenterol Motil. 2011;23(9):819‐830. doi:10.1111/j.1365-2982.2011.01738.xMittal RK.Motor Function of the Pharynx, Esophagus, and its Sphincters. San Rafael (CA): Morgan & Claypool Life Sciences; 2011. Upper Esophageal Sphincter. Available from: https://www.ncbi.nlm.nih.gov/books/NBK54282/Martinez JC, Lima GR, Silva DH, et al.Clinical, endoscopic and manometric features of the primary motor disorders of the esophagus. Arq Bras Cir Dig. 2015;28(1):32-5. doi:10.1590/S0102-67202015000100009Desai JP, Moustarah F.Esophageal Stricture. [Updated 2019 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/Roman S, Kahrilas PJ.Management of spastic disorders of the esophagus. Gastroenterol Clin North Am. 2013;42(1):27-43. doi:10.1016/j.gtc.2012.11.002Momodu II, Wallen JM.Achalasia. [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol. 2019;2019:5036160. Published 2019 Mar 3. doi:10.1155/2019/5036160Lufrano R, Heckman MG, Diehl N, DeVault KR, Achem SR.Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.Dis Esophagus. 2015;28(1):11‐18. doi:10.1111/dote.12160Patti MG, Diener U, Tamburini A, Molena D, Way LW.Role of esophageal function tests in diagnosis of gastroesophageal reflux disease.Dig Dis Sci. 2001;46(3):597‐602. doi:10.1023/a:1005611602100Chen JH.Ineffective esophageal motility and the vagus: current challenges and future prospects.Clin Exp Gastroenterol. 2016;9:291‐299. Published 2016 Sep 20. doi:10.2147/CEG.S111820Chen A, Tuma F.Barium Swallow. [Updated 2020 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493176/Carlson DA, Pandolfino JE.High-Resolution Manometry in Clinical Practice.Gastroenterol Hepatol (N Y). 2015;11(6):374‐384.American Society for Gastrointestinal Endoscopy (ASGE).Understanding Esophageal Manometry. asge.orgOrtiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V.Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function.Dis Esophagus. 2017;30(3):1‐4. doi:10.1111/dote.12523Wang A, Pleskow DK, Banerjee S, et al.Esophageal function testing. Gastrointest Endosc. 2012;76(2):231-43. doi:10.1016/j.gie.2012.02.022Cleveland Clinic.Esophageal diverticulum.Cleveland Clinic.Esophageal spasms.

19 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yadlapati, R.; Gawron, A.; Keswani, R. et al.Identification of Quality Measures for Performance of and Interpretation of Data From Esophageal Manometry.Clin Gastroenterol Hepatol.2016;14:526-34. doi:10.1016/j.cgh.2015.10.006Sharma, N. and Freeman, J. (2012). “Chapter 8: Esophageal Manometry.“The Esophagus (5th Edition).Eds: Richter, J. and Castell, D. Hoboken, New Jersey: Blackwell Publishing. doi:10.1002/9781444346220Hershcovici T, Mashimo H, Fass R.The lower esophageal sphincter.Neurogastroenterol Motil. 2011;23(9):819‐830. doi:10.1111/j.1365-2982.2011.01738.xMittal RK.Motor Function of the Pharynx, Esophagus, and its Sphincters. San Rafael (CA): Morgan & Claypool Life Sciences; 2011. Upper Esophageal Sphincter. Available from: https://www.ncbi.nlm.nih.gov/books/NBK54282/Martinez JC, Lima GR, Silva DH, et al.Clinical, endoscopic and manometric features of the primary motor disorders of the esophagus. Arq Bras Cir Dig. 2015;28(1):32-5. doi:10.1590/S0102-67202015000100009Desai JP, Moustarah F.Esophageal Stricture. [Updated 2019 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/Roman S, Kahrilas PJ.Management of spastic disorders of the esophagus. Gastroenterol Clin North Am. 2013;42(1):27-43. doi:10.1016/j.gtc.2012.11.002Momodu II, Wallen JM.Achalasia. [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol. 2019;2019:5036160. Published 2019 Mar 3. doi:10.1155/2019/5036160Lufrano R, Heckman MG, Diehl N, DeVault KR, Achem SR.Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.Dis Esophagus. 2015;28(1):11‐18. doi:10.1111/dote.12160Patti MG, Diener U, Tamburini A, Molena D, Way LW.Role of esophageal function tests in diagnosis of gastroesophageal reflux disease.Dig Dis Sci. 2001;46(3):597‐602. doi:10.1023/a:1005611602100Chen JH.Ineffective esophageal motility and the vagus: current challenges and future prospects.Clin Exp Gastroenterol. 2016;9:291‐299. Published 2016 Sep 20. doi:10.2147/CEG.S111820Chen A, Tuma F.Barium Swallow. [Updated 2020 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493176/Carlson DA, Pandolfino JE.High-Resolution Manometry in Clinical Practice.Gastroenterol Hepatol (N Y). 2015;11(6):374‐384.American Society for Gastrointestinal Endoscopy (ASGE).Understanding Esophageal Manometry. asge.orgOrtiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V.Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function.Dis Esophagus. 2017;30(3):1‐4. doi:10.1111/dote.12523Wang A, Pleskow DK, Banerjee S, et al.Esophageal function testing. Gastrointest Endosc. 2012;76(2):231-43. doi:10.1016/j.gie.2012.02.022Cleveland Clinic.Esophageal diverticulum.Cleveland Clinic.Esophageal spasms.

Yadlapati, R.; Gawron, A.; Keswani, R. et al.Identification of Quality Measures for Performance of and Interpretation of Data From Esophageal Manometry.Clin Gastroenterol Hepatol.2016;14:526-34. doi:10.1016/j.cgh.2015.10.006Sharma, N. and Freeman, J. (2012). “Chapter 8: Esophageal Manometry.“The Esophagus (5th Edition).Eds: Richter, J. and Castell, D. Hoboken, New Jersey: Blackwell Publishing. doi:10.1002/9781444346220Hershcovici T, Mashimo H, Fass R.The lower esophageal sphincter.Neurogastroenterol Motil. 2011;23(9):819‐830. doi:10.1111/j.1365-2982.2011.01738.xMittal RK.Motor Function of the Pharynx, Esophagus, and its Sphincters. San Rafael (CA): Morgan & Claypool Life Sciences; 2011. Upper Esophageal Sphincter. Available from: https://www.ncbi.nlm.nih.gov/books/NBK54282/Martinez JC, Lima GR, Silva DH, et al.Clinical, endoscopic and manometric features of the primary motor disorders of the esophagus. Arq Bras Cir Dig. 2015;28(1):32-5. doi:10.1590/S0102-67202015000100009Desai JP, Moustarah F.Esophageal Stricture. [Updated 2019 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/Roman S, Kahrilas PJ.Management of spastic disorders of the esophagus. Gastroenterol Clin North Am. 2013;42(1):27-43. doi:10.1016/j.gtc.2012.11.002Momodu II, Wallen JM.Achalasia. [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol. 2019;2019:5036160. Published 2019 Mar 3. doi:10.1155/2019/5036160Lufrano R, Heckman MG, Diehl N, DeVault KR, Achem SR.Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.Dis Esophagus. 2015;28(1):11‐18. doi:10.1111/dote.12160Patti MG, Diener U, Tamburini A, Molena D, Way LW.Role of esophageal function tests in diagnosis of gastroesophageal reflux disease.Dig Dis Sci. 2001;46(3):597‐602. doi:10.1023/a:1005611602100Chen JH.Ineffective esophageal motility and the vagus: current challenges and future prospects.Clin Exp Gastroenterol. 2016;9:291‐299. Published 2016 Sep 20. doi:10.2147/CEG.S111820Chen A, Tuma F.Barium Swallow. [Updated 2020 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493176/Carlson DA, Pandolfino JE.High-Resolution Manometry in Clinical Practice.Gastroenterol Hepatol (N Y). 2015;11(6):374‐384.American Society for Gastrointestinal Endoscopy (ASGE).Understanding Esophageal Manometry. asge.orgOrtiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V.Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function.Dis Esophagus. 2017;30(3):1‐4. doi:10.1111/dote.12523Wang A, Pleskow DK, Banerjee S, et al.Esophageal function testing. Gastrointest Endosc. 2012;76(2):231-43. doi:10.1016/j.gie.2012.02.022Cleveland Clinic.Esophageal diverticulum.Cleveland Clinic.Esophageal spasms.

Sharma, N. and Freeman, J. (2012). “Chapter 8: Esophageal Manometry.“The Esophagus (5th Edition).Eds: Richter, J. and Castell, D. Hoboken, New Jersey: Blackwell Publishing. doi:10.1002/9781444346220

Hershcovici T, Mashimo H, Fass R.The lower esophageal sphincter.Neurogastroenterol Motil. 2011;23(9):819‐830. doi:10.1111/j.1365-2982.2011.01738.x

Mittal RK.Motor Function of the Pharynx, Esophagus, and its Sphincters. San Rafael (CA): Morgan & Claypool Life Sciences; 2011. Upper Esophageal Sphincter. Available from: https://www.ncbi.nlm.nih.gov/books/NBK54282/

Martinez JC, Lima GR, Silva DH, et al.Clinical, endoscopic and manometric features of the primary motor disorders of the esophagus. Arq Bras Cir Dig. 2015;28(1):32-5. doi:10.1590/S0102-67202015000100009

Desai JP, Moustarah F.Esophageal Stricture. [Updated 2019 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/

Roman S, Kahrilas PJ.Management of spastic disorders of the esophagus. Gastroenterol Clin North Am. 2013;42(1):27-43. doi:10.1016/j.gtc.2012.11.002

Momodu II, Wallen JM.Achalasia. [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/

Clément M, Zhu WJ, Neshkova E, Bouin M.Jackhammer Esophagus: From Manometric Diagnosis to Clinical Presentation.Can J Gastroenterol Hepatol. 2019;2019:5036160. Published 2019 Mar 3. doi:10.1155/2019/5036160

Lufrano R, Heckman MG, Diehl N, DeVault KR, Achem SR.Nutcracker esophagus: demographic, clinical features, and esophageal tests in 115 patients.Dis Esophagus. 2015;28(1):11‐18. doi:10.1111/dote.12160

Patti MG, Diener U, Tamburini A, Molena D, Way LW.Role of esophageal function tests in diagnosis of gastroesophageal reflux disease.Dig Dis Sci. 2001;46(3):597‐602. doi:10.1023/a:1005611602100

Chen JH.Ineffective esophageal motility and the vagus: current challenges and future prospects.Clin Exp Gastroenterol. 2016;9:291‐299. Published 2016 Sep 20. doi:10.2147/CEG.S111820

Chen A, Tuma F.Barium Swallow. [Updated 2020 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493176/

Carlson DA, Pandolfino JE.High-Resolution Manometry in Clinical Practice.Gastroenterol Hepatol (N Y). 2015;11(6):374‐384.

American Society for Gastrointestinal Endoscopy (ASGE).Understanding Esophageal Manometry. asge.org

Ortiz V, Sáez-González E, Blé M, Díaz-Jaime FC, Vinaixa C, Garrigues V.Effects of high-resolution esophageal manometry on oxygen saturation and hemodynamic function.Dis Esophagus. 2017;30(3):1‐4. doi:10.1111/dote.12523

Wang A, Pleskow DK, Banerjee S, et al.Esophageal function testing. Gastrointest Endosc. 2012;76(2):231-43. doi:10.1016/j.gie.2012.02.022

Cleveland Clinic.Esophageal diverticulum.

Cleveland Clinic.Esophageal spasms.

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