Oesophageal manometry preparation

Overview

Oesophageal manometry is a test that measures how well the muscles in your food pipe (oesophagus) are working. It helps doctors understand problems with swallowing or chest pain that may be related to muscle or nerve issues in the oesophagus.

Oesophageal manometry is not a routine test but is commonly performed in specialist gastrointestinal (GI) clinics when other tests have not provided a clear diagnosis.

The test is used for people of any age who have difficulty swallowing, chest pain that is not related to the heart, or persistent heartburn that does not respond to treatment.

Symptoms

Common symptoms

• Difficulty swallowing (dysphagia) – feeling that food sticks in the chest or throat
• Pain or discomfort in the chest that is not related to the heart
• Heartburn that does not improve with medication
• Regurgitation – bringing food or sour liquid back into the mouth
• Chronic cough or hoarseness that may be linked to acid reflux

Symptoms in children

• Trouble feeding or swallowing milk/formula
• Unexplained vomiting or spitting up
• Poor weight gain or failure to thrive
• Frequent coughing or choking during meals

Symptoms in older adults

• Difficulty swallowing solids or liquids
• Unexplained weight loss due to avoiding food
• Chest discomfort that may be mistaken for heart problems
• Aspiration pneumonia (lung infection from food/liquid going into the lungs)

Causes

Main causes

• Achalasia – a condition where the muscle at the lower end of the oesophagus does not relax properly, causing food to get stuck.
• Diffuse oesophageal spasm – uncoordinated or tight contractions of the oesophagus muscles.
• Scleroderma – a connective tissue disease that can stiffen the oesophagus.
• Gastro-oesophageal reflux disease (GORD) – when stomach acid frequently flows back into the oesophagus.

Risk factors

• Age – certain conditions like achalasia are more common in middle-aged adults.
• Autoimmune diseases (e.g., scleroderma, lupus)
• Long-term poorly controlled acid reflux
• Anxiety or stress, which can worsen oesophageal muscle function

When to see a doctor

See a doctor urgently if:

• If you cannot swallow at all or have severe chest pain
• If you are losing weight unintentionally because of swallowing difficulties

Book a routine appointment if:

• If you have had heartburn or regurgitation for several weeks that does not improve with lifestyle changes or over-the-counter treatments
• If you have mild difficulty swallowing solid foods that is gradually getting worse

Diagnosis

Oesophageal manometry is performed to evaluate the function of the oesophagus. Before the test, you will be asked to stop taking certain medicines that affect the oesophagus (such as acid-suppressing drugs) for 1-2 days – your doctor will tell you which ones. You should not eat or drink anything for 6-8 hours before the test. The test itself takes about 30-40 minutes.

Tests that may be done

• Oesophageal manometry – the main test, where a thin tube is placed through your nose into the oesophagus to measure pressure
• Upper endoscopy (gastroscopy) – often done first to rule out other problems like strictures or cancer
• Barium swallow – X-ray test using a chalky drink to see the shape of the oesophagus

What to expect at your appointment

Before the test, you will be told to stop eating and drinking for several hours. You will be awake during the test. A small tube (catheter) is gently passed through one nostril down into your oesophagus. You may feel some discomfort, but it is usually well tolerated. You will then be asked to swallow small amounts of water while the machine records the pressure in your oesophagus. There may be a slight sore throat afterwards, but this goes away quickly.

Treatment

Treatment depends on the condition found. The goal is to improve swallowing and reduce pain or discomfort. Options range from lifestyle changes to medicines, and in some cases, procedures or surgery.

Self-care at home

• Eat smaller, more frequent meals
• Chew food thoroughly and eat slowly
• Avoid foods that trigger symptoms (e.g., spicy, fatty, or acidic foods)
• Stay upright after eating for at least 30 minutes
• Elevate the head of your bed by 15-20 cm (6-8 inches) to reduce nighttime reflux

Medical treatments

Your doctor may recommend medicines that help relax the oesophagus muscles or reduce stomach acid. In some cases, a procedure called pneumatic dilation (stretching the lower oesophageal muscle) or botulinum toxin injections into the muscle can help. All treatments should be discussed with your healthcare provider – do not start or stop any medication without advice.

When is surgery considered?

For conditions like achalasia that do not respond to other treatments, a surgical procedure called myotomy (cutting the tight muscle) may be considered. This is usually done with keyhole surgery. Your specialist will explain if this is an option for you.

Living with this condition

Living with a swallowing disorder can be challenging, but most people can manage symptoms effectively with the right treatment plan. Keep a diary of your symptoms and what helps or makes them worse. Work closely with your healthcare team to adjust your management as needed.

Lifestyle tips

• Practice mindful eating – pay attention to your food and avoid distractions
• Maintain a healthy weight to reduce pressure on the stomach
• Avoid eating within 3 hours of bedtime
• Manage stress through relaxation techniques like deep breathing or meditation

Diet and exercise

A soft or liquid diet may help during flare-ups. Stay hydrated by sipping water throughout the day. Regular gentle exercise, such as walking, can improve overall digestion and reduce stress. Avoid strenuous exercise immediately after meals.

Mental health and emotional wellbeing

Chronic swallowing problems can cause anxiety, especially around mealtimes or in social situations. It is normal to feel frustrated or worried. Talk to your doctor if these feelings are affecting your quality of life – they can refer you to a counsellor or support group.

Prevention

Most conditions that cause oesophageal muscle problems cannot be prevented because they are related to autoimmune processes or unknown causes. However, managing acid reflux early and avoiding triggers may help reduce the risk of complications.

Vaccines

There are no vaccines for oesophageal motility disorders.

Complications

If left untreated

• Weight loss and malnutrition due to difficulty eating
• Aspiration pneumonia (lung infection from food or liquid going into the lungs)
• Worsening acid reflux causing damage to the oesophagus lining (oesophagitis)
• Development of a condition called Barrett's oesophagus (pre-cancerous changes) from long-term severe reflux

Long-term outlook

With proper diagnosis and treatment, most people with oesophageal motility disorders can manage their symptoms and maintain a good quality of life. Some conditions may require ongoing care, but advances in treatment mean that many people improve significantly. Early diagnosis gives the best chance of successful management.

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