An esophageal motility study (EMS) or esophageal manometry is a test to assess motor function of the Upper Esophageal Sphincter (UES), Esophageal body and Lower Esophageal Sphincter (LES).

Indications

An EMS is typically done to evaluate suspected disorders of motility

Motility

Motility is a biological term which refers to the ability to move spontaneously and actively, consuming energy in the process. Most animals are motile but the term applies to single-celled and simple multicellular organisms, as well as to some mechanisms of fluid flow in multicellular organs, in...

 or peristalsis

Peristalsis

Peristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...

 of the esophagus. These include achalasia

Achalasia

Achalasia , also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter...

, diffuse esophageal spasm, nutcracker esophagus

Nutcracker esophagus

Nutcracker esophagus is a disorder of the movement of the esophagus, and is one of many motility disorders of the esophagus, including achalasia and diffuse esophageal spasm. It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause chest pain; it may also be...

 and hypertensive lower esophageal sphincter. These disorders typically present with dysphagia

Dysphagia

Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia....

, or difficulty swallowing, usually to both solids and liquids even initially. Other patients with spasm disorders may have the test done to diagnose chest pain

Chest pain

Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...

 thought not to be of cardiac cause. The test is not useful for anatomical disorders of the esophagus (that is, disorders that distort the anatomy of the esophagus), such as peptic strictures

Esophageal stricture

Benign esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing difficulties.-Causes:It can be caused by or associated with gastroesophageal reflux disease, esophagitis , dysfunctional lower esophageal sphincter, disordered motility, lye ingestion, or a hiatal hernia...

 and esophageal cancer

Esophageal cancer

Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma . Squamous cell cancer arises from the cells that line the upper part of the esophagus...

.

Procedure

A technician places a catheter into the nose and guides it into the stomach. Once placed, the catheter is slowly withdrawn, allowing it to detect pressure changes and to record information for later review. The patient will be asked at various times to take a deep breath or to take some swallows of water. The degree of discomfort varies among patients. Patients are not sedated because sedatives would alter the functioning of the esophageal muscles. Overall the procedure takes about 45 minutes. After the procedure is complete, patients can usually resume their normal daily activities.

Recent advances in esophageal motility testing

Recently, high resolution manometry

High resolution manometry

High-resolution manometry is a gastrointestinal motility diagnostic system that measures intraluminal pressure activity within the gastrointestinal tract using a series of closely spaced pressure sensor. For a manometry system to be classified as "high resolution" as opposed to "conventional",...

(HRM) has been developed that significantly reduces the procedure time (10 minutes vs. 45 mins with conventional manometry) and provides enhanced patient comfort. Newer catheters also incorporate concurrent impedance with HRM.

External links

• Diagram at gi.vghtc.gov.tw

http://www.hrmconsensus.org/files/Pandolfino%20Fox_NGM09_HRM%20Consensus.pdf
High Resolution Oesophageal Manometry systmems