A reason to have the manometry

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The following was copied from an article by Dr. Achkar at the Cleveland Clinic. The entire article can be reviewed here. If you click on the figures 4 through 8 in this article on the website you can see the pictures. I don't think you can do that from the email.

Maggie

Esophageal ManometryEsophageal manometry is the most specific test for determining the exact nature of the motor abnormality. The test is indicated in cases of dysphagia where structural lesions have already been ruled out by x-ray or endoscopy. The yield is very low in patients with non-cardiac chest pain without dysphagia. In those cases, prolonged pH monitoring is more useful since acid reflux causing chest pain is more frequent than disordered peristalsis. The AGA guidelines outline appropriately the indications for esophageal manometry.8

Esophageal manometry is indicated:

To establish the diagnosis of achalasia and diffuse spasm To detect motor abnormalities associated with systemic disease if diagnosis or management is affected by the results To place intraluminal devices (pH monitoring) Preoperative evaluation of patients considered for antireflux surgery

Esophageal manometry nonindicated:

As a screening test As initial test for chest pain To establish the diagnosis of acid reflux To assess results of antireflux surgery

In normal individuals, esophageal motility testing reveals normal progression of the peristaltic wave with timely relaxation of the lower esophageal sphincter (Figure 4). In achalasia, LES relaxation is partial and ill-timed and peristalsis is totally absent (Figure 5). In diffuse esophageal spasm, tertiary contractions are seen with alternating normal contractions (Figure 6). The nutcracker esophagus reveals high amplitude long-duration contractions (Figure 7). Patients with ineffective motility most often due to reflux disease show intermittent lack of progression in the distal esophagus and low amplitude contractions (Figure 8). Other motor abnormalities do not correspond to any clinical syndrome and they are referred to as non-specific motor changes, a convenient but not clinically relevant category.9