Norm of Esophageal Manometry
|Esophageal pressures||Equal bilaterally|
|Motility||Smooth peristalsis proximally to distally|
|Proportion of propulsive waves||56% median|
|Proportion of simultaneous waves||10%|
Usage of Esophageal Manometry
Assessment and diagnosis of achalasia, dysphagia, esophageal reflux, spasm, motility abnormalities, and hiatal hernia.
Description of Esophageal Manometry
In esophageal manometry, a multilumen esophageal catheter is introduced through the mouth and oropharynx into the esophagus, and pressures along the esophagus are measured as the client performs a series of swallowing maneuvers. The test helps identify locations of abnormal contractions and peristalsis in the esophagus as well as areas of increased pressure that would indicate esophageal spasm and achalasia. The test may be performed with the esophageal acidity (Tuttle) test and the acid perfusion (Bernstein) test. It has been used extensively in the research setting in the study of esophageal motility disorders and is less commonly used in the clinical setting.
Professional Considerations of Esophageal Manometry
Consent form IS required.
Vasovagal reaction, dysrhythmia, cyanosis, or coughing.
Clients at high risk for poor tolerance of a vasovagal reaction (that is, clients with known cardiac instability).
- Verify that the client has fasted.
- The client should void just before the test.
- Obtain a gastric catheter, a swallowing sensor, water, and a syringe.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- Place the client in a high-Fowler's position.
- Introduce the catheter through the mouth to the back of the throat. Instruct the client to swallow the catheter several times until it has passed into the esophagus to the proper level.
- Reposition the client in a supine position.
- Attach the swallowing sensor to the client's neck.
- The client is then asked to swallow small amounts of water injected into the mouth with a syringe, and the esophageal pressures are measured. This is followed by several dry swallows with corresponding pressure measurements.
- Assess vital signs every 30 minutes × 2. Extend assessments as needed if the client was treated for a vasovagal reaction during the procedure.
- Observe for cholinergic side effects: bradycardia, dizziness, diaphoresis, flushing, muscle cramping, nausea, urinary urgency, and vomiting.
Client and Family Teaching
- Fast from midnight before the test and avoid smoking for 24 hours before the test.
- Do not drink alcohol or take any of these drugs within 2 days before the test: bethanechol, diltiazem or other calcium channel blockers, chlordiazepoxide, cimetidine, Donnatal, erythromycin, famotidine, Inderal or other beta blockers, lansoprazole, Levsin, metoclopramide, L-hyoscyamine, nitroglycerin or other nitrates, nizatidine, omeprazole, or ranitidine.
- Arrange for transportation home because you will not be allowed to drive for 12–24 hours after receiving edrophonium chloride.
- You must swallow a catheter with a small electrode attached. You will then be asked to swallow several times, first with small amounts of water injected into the mouth and then without water. The catheter and neck sensor will measure the pressures in the esophagus as you swallow. After the measurements are taken, the catheter will be slowly pulled out of the stomach.
- The test takes 30 minutes or less.
- Irritation of nose and throat are common problems for up to 8 hours post procedure.
Factors That Affect Results