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Introduction ⬇

Esophageal manometry is a test that measures the movement, coordination, and strength of esophageal peristalsis as well as the function of the upper and lower esophageal sphincters. It consists of recording intraluminal pressures at various levels in the esophagus and at the upper and lower esophageal sphincters. Intraluminal pressures can be measured with the use of a manometric catheter, which is passed intranasally and then attached to an infusion pump, transducer, and recorder. The intraluminal pressures produce waveform readings (somewhat similar to ECG readings), which can be used to assess esophageal function.

  1. Abnormal esophageal muscle function

  2. Difficulty swallowing (dysphagia)

  3. Heartburn

  4. Noncardiac chest pain

  5. Regurgitation

  6. Vomiting

  7. Esophagitis

Procedure ⬆ ⬇

  1. The examination is usually performed in an outpatient setting, such as an ambulatory clinic or healthcare provider's office.

  2. Attach the manometric catheter to the infusion pump. Set up the transducer and recording equipment and calibrate according to manufacturer's recommendations.

  3. Assess the patient's nasal passage for adequate size and patency. Generously apply a topical anesthetic to the selected nostril.

  4. Lubricate the manometric catheter and pass it through the nostril, down the esophagus, and just below the lower esophageal sphincter with the patient in a sitting position. Facilitate this with the patient drinking sips of water through a straw.

  5. Begin recording. Pull the catheter through the lower esophageal sphincter, then the esophageal body, and finally the upper esophageal sphincter. Different techniques may be used to obtain recordings. The patient may be asked to swallow, not swallow, take sips of water, or hold their breath while the catheter is pulled through.

  6. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal recordings reveal the following conditions:

  1. Primary esophageal motility disorders, such as achalasia, nutcracker esophagus, or diffuse esophageal spasm

  2. Hypertensive lower esophageal sphincter

  3. Acid reflux

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, benefits, and risks of the test.

  2. Obtain an informed consent that is properly signed and witnessed.

  3. Confirm that the patient has fasted for 6 hours before testing.

  4. Instruct the patient on the techniques of swallowing, sipping water, and so forth to facilitate accurate recordings.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Advise the patient that a sore throat and nasal passage irritation are common for 24 hours after the examination. Sensations of heartburn may also persist. Administer antacids if ordered.

  2. Observe for or instruct patient to watch for nasal bleeding, signs and symptoms of GI bleeding, or unusual pain.

  3. Review test results; report and record findings. Modify the nursing care plan as needed.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care. Provide written discharge instructions.

Clinical Alert

Complications are rare; however, the following can occur: aspiration; perforation of nasopharynx, esophagus, or stomach; and epistaxis

Reference Values ⬆

Normal