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Manometry

By

Jonathan Gotfried

, MD, Lewis Katz School of Medicine at Temple University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Manometry is measurement of pressure within various parts of the gastrointestinal tract. It is done by passing a catheter containing solid-state or liquid-filled pressure transducers through the mouth or anus into the lumen of the organ to be studied. Manometry typically is done to evaluate motility disorders in patients in whom structural lesions have been ruled out by other studies. Manometry is used in the esophagus, stomach and duodenum, sphincter of Oddi, and rectum. Aside from minor discomfort, complications are very rare. Patients must have nothing by mouth (npo) after midnight.

Anorectal manometry

In this test, a pressure transducer is placed in the anus to evaluate the anorectal sphincter mechanism and rectal sensation in patients with incontinence or constipation Constipation Constipation is difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation. (See also Constipation in Children.) No bodily function is more variable and... read more . It can help diagnose Hirschsprung disease Hirschsprung Disease Hirschsprung disease is a congenital anomaly of innervation of the lower intestine, usually limited to the colon, resulting in partial or total functional obstruction. Symptoms are obstipation... read more Hirschsprung Disease and defecation disorders and provide biofeedback training for fecal incontinence Fecal Incontinence Fecal incontinence is involuntary defecation. (See also Evaluation of Anorectal Disorders.) Fecal incontinence can result from injuries or diseases of the spinal cord, congenital abnormalities... read more . A barostat balloon is also inflated during the test to evaluate rectal sensation and accommodation. The balloon expulsion test, which is often done together with anorectal manometry, allows for objective assessment of evacuation function.

Barostat

This is a pressure-sensing device that is placed in the stomach to measure gastric accommodation. The device consists of a plastic balloon and an electronic controller that varies the amount of air in the balloon to maintain constant pressure. This device is used mainly in research studies assessing sensory threshold and altered visceral perception, particularly in functional gastrointestinal disorders.

Esophageal manometry

This test is used to evaluate patients with dysphagia Dysphagia Dysphagia is difficulty swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Dysphagia should not be confused with globus sensation... read more , heartburn Gastroesophageal Reflux Disease (GERD) Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia... read more Gastroesophageal Reflux Disease (GERD) , regurgitation, or chest pain Chest Pain Chest pain is a very common complaint. Many patients are well aware that it is a warning of potential life-threatening disorders and seek evaluation for minimal symptoms. Other patients, including... read more . It measures the pressure in the upper and lower esophageal sphincters, determines the effectiveness and coordination of propulsive movements, and detects abnormal contractions. Manometry can be used to diagnose esophageal motility disorders Esophageal Motility Disorders Esophageal motility disorders involve dysfunction of the esophagus that causes symptoms such as dysphagia, heartburn, and chest pain. (See also Overview of Esophageal and Swallowing Disorders... read more such as achalasia Achalasia Achalasia is a neurogenic esophageal motility disorder characterized by impaired esophageal peristalsis and a lack of lower esophageal sphincter relaxation during swallowing. Symptoms are slowly... read more , diffuse spasm Diffuse Esophageal Spasm Symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders characterized variously by nonpropulsive contractions and hyperdynamic contractions, sometimes in conjunction... read more , systemic sclerosis Systemic Sclerosis Systemic sclerosis is a rare chronic disease of unknown cause characterized by diffuse fibrosis and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus... read more Systemic Sclerosis , and lower esophageal sphincter hypotension and hypertension. It also is used to evaluate esophageal function and anatomy such as hiatus hernia Hernias of the Abdominal Wall A hernia of the abdominal wall is a protrusion of the abdominal contents through an acquired or congenital area of weakness or defect in the wall. Many hernias are asymptomatic, but some become... read more Hernias of the Abdominal Wall before certain therapeutic procedures (eg, antireflux surgery, pneumatic dilation for achalasia). High-resolution manometry is often combined with impedance planimetry to simultaneously evaluate bolus transit through the esophagus during the test swallows (1 Esophageal manometry references Manometry is measurement of pressure within various parts of the gastrointestinal tract. It is done by passing a catheter containing solid-state or liquid-filled pressure transducers through... read more , 2 Esophageal manometry references Manometry is measurement of pressure within various parts of the gastrointestinal tract. It is done by passing a catheter containing solid-state or liquid-filled pressure transducers through... read more ).

Esophageal manometry references

  • 1. Gyawali CP, Carlson DA, Chen JW, et al: ACG clinical guidelines: Clinical use of esophageal physiologic testing. Am J Gastroenterol 115(9):1412–1428, 2020. doi: 10.14309/ajg.0000000000000734

  • 2. Hirano I, Pandolfino JE, Boeckxstaens GE: Functional lumen imaging probe for the management of esophageal disorders: Expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol 15(3):325–334, 2017. doi: 10.1016/j.cgh.2016.10.022

Gastroduodenal manometry

In this test, transducers are placed in the gastric antrum, duodenum, and proximal jejunum. Pressure is monitored for 5 to 24 hours in both fasting and fed states. This test is usually used in patients who have symptoms suggestive of dysmotility but have normal gastric emptying study results or who are unresponsive to therapy. It can help determine whether the patient's symptoms or dysmotility result from a muscular disorder (abnormal contraction amplitude but normal pattern) or nerve disorder (irregular contraction pattern but normal amplitude).

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