Esophagomanometry (from other Greek. Οἰσο-φάγος - esophagus + other Greek. Μάνωσις - dilution + other Greek. Μέτρον - measure, meter ) or Manometry of the esophagus - a diagnostic study that allows you to evaluate the contractility of the esophagus peristalsis with the work of the lower and upper esophageal sphincters (NPS and CHD).
Esophagus manometry is used as a diagnostic procedure for diseases of the esophagus, performed using a multi-channel water-perfusion catheter, with which the pressure inside the lumen of the esophagus is measured.
Catheters are inserted into the lumen of the esophagus orally (through the mouth) or transnasally (through the nose).
The first manometric studies of the human esophagus were made by Hugo Kronecker and Samuel Melzer in 1883 .
The principle of the water-perfusion catheter
The principle of operation of a water-perfusion catheter is that it contains capillaries that open at certain points on the surface of the catheter (ports). Each capillary is connected to an external pressure sensor and a water pump, which delivers water at a speed of 0.5 ml / min into the capillary. The pressure change in the region of the capillary port is transmitted through a column of water to a pressure sensor and then to a recording device for graphical display. The most commonly used catheter is with four or eight capillaries.
Indications for manometry
Esophagomanometry is performed in patients with symptoms that indicate their connection with the pathology of the esophagus, such as dyspepsia , dysphagia , odnophagia , and non-coronary pain in the chest. In addition, a gauge examination is shown to patients before antireflux surgery and to assess the involvement of the esophagus in systemic diseases such as scleroderma , chronic idiopathic pseudo-obstruction (Table 1).
Key clinical indications for esophageal manometry
|Study of patients with dyspepsia||Anomalies of the upper esophageal sphincter and pharynx|
Primary disorders of motility of the esophagus ( achalasia of the cardia , esophagus-nutcracker , diffuse spasm of the esophagus , hypertonicity of the lower esophageal sphincter )
|Study of patients with possible gastroesophageal reflux disease||Help determine the position of the pH probe|
The study of pressure of the lower esophageal sphincter
Assessment of defects of peristalsis (especially before fundoplication (from lat. Fundus ventriculi )
|A study of patients with non-cardiac chest pain||Primary disorders of esophageal motility|
Painful response to provocative tests
|Evaluation of possible involvement of the esophagus in systemic diseases||Scleroderma|
Chronic idiopathic intestinal pseudo-obstruction diabetes mellitus
|Exclusion of esophageal etiology with suspected anorexia nervosa|
Contraindications for manometry
Contraindications to manometry, as in other probe procedures, are:
- acute destructive esophagitis ,
- aortic aneurysm ,
- persistent cough and vomiting ,
- general serious condition, etc.
Manifestation of the lower esophageal sphincter
When manometer NPS measure resting pressure and evaluate its relaxation in the process of swallowing a small amount of water (percentage of relaxation, residual pressure, duration of relaxation). In addition, the location of the NPS (the distance to the NPS from the entrance to the external nasal passage) and the total length of the NPS are determined. The normal values of these parameters are given in table. 2.
Normal values in the study of NPS. table 2
|NPS quiescent pressure||6-25 mm Hg|
|at the end of a breath||40 ± 13 mmHg|
|the average||24 ± 10 mmHg|
|at the end of exhalation||15 ± 11 mmHg|
|NPS relaxation duration||5-12 s|
|NPC relaxation||More than 90%|
|total length||20-40 mm|
NPS quiescent pressure is the point of the highest pressure of the NPS detected during manometry.
Assessment of relaxation of the NPS - this study is usually carried out in the process of swallowing 5 ml of room temperature water, since a “dry sip” does not cause sufficient relaxation of the NPS. After swallowing, the pressure of the NPS usually decreases to about the level of the base pressure of the stomach , followed by a rise.
At the same time it is estimated:
- duration of relaxation .
- percent relaxation - estimated% reduction in NPS pressure during relaxation relative to the level of NPS at rest, which is 100%.
- residual pressure (the difference between the lowest pressure achieved during the relaxation process and the base pressure of the stomach). Residual pressure is considered to be a better indicator of NPS function than relaxation percentage, since it does not depend on the level of NPS pressure at rest. Normally, the residual pressure should be 8 mmHg. Art. and below.
Esophageal body manometry
The manometry of the body of the esophagus involves measuring the amplitude, duration and speed of contractions.
The amplitude shows how closely the muscles of the esophagus contract during the contractions. Duration indicates how long the muscles of the esophagus are compressed in the process of contraction. Speed characterizes the spread of contraction down the esophagus. Normal indicators of motility of the esophagus are given in table. 3.
Normal esophageal motility. Table 3
|Recording point||Wet gulp|
|Amplitude, mmHg||Duration, s||Speed, cm / s|
|18 cm above the NPC||62 ± 29||2.9 ± 0.8|
|13 cm above the NPC||70 ± 32||3.5 ± 0.7|
|8 cm above the NPC||90 ± 41||3.9 ± 0.9|
|3 cm above the NPC||109 ± 45||4.0 ± 1.1|
|Middle third||99 ± 40||3.9 ± 0.9|
|Proximal||3.0 ± 0.6|
|Distal section||3.5 ± 0.9|
The entire study procedure takes 20-30 minutes.
The clinical significance of esophageal manometry is to accurately confirm the diagnoses associated with impaired motility of the esophagus, which can initially be assumed using anamnesis, esophagoscopy, and other methods. The esophagus manometry is of fundamental importance when planning antireflux surgical operations and quality control after them.
Manometry of the upper esophageal sphincter
The manometry of the upper esophageal sphincter, like the manometry of the NPS, provides for the determination of:
- determination of resting pressure;
- relaxation (% relaxation);
- long relaxation.
Like the NPS, the upper esophageal sphincter is tonically shortened and relaxes during swallowing. At the same time, the upper esophageal sphincter and pharyngeal region have anatomical features that distinguish them from the body and NPS and have a clear effect on manometry. They are made of striated muscles , so muscle contractions are much faster than that of the smooth muscles of the distal esophagus.
- Pharyngeal manometry
- Bordin D.S., Bor S. Manometry as a method for evaluating the motor function of the esophagus . Central Research Institute of Gastroenterology, M. Experimental and clinical gastroenterology. 2006, No. 3, p. 13-20.
- Bordin D.S., Valitova E.R. Methodology and clinical significance of esophageal manometry / Ed. MD, prof. L. B. Lazebnika. - M.: Publishing House MEDPRAKTIKA-M, 2009, 24 p. ISBN 978-5-98803-172-7 .