From the Guidelines
Esophageal manometry is primarily indicated for establishing the diagnosis of dysphagia when a mechanical obstruction cannot be found, particularly if achalasia is suspected, as stated in the American Gastroenterological Association medical position statement 1. The indications for esophageal manometry can be broken down into several key areas:
- Diagnosis of dysphagia when a mechanical obstruction is not present, with a particular emphasis on suspected achalasia
- Placement of intraluminal devices such as pH probes, where accurate positioning relative to functional landmarks like the lower esophageal sphincter is crucial
- Preoperative assessment for antireflux surgery, especially when there's a question of an alternative diagnosis like achalasia, as highlighted in the recommendations 1 Some possible indications for esophageal manometry include:
- Preoperative assessment of peristaltic function in patients considered for antireflux surgery
- Evaluation of symptoms of dysphagia in patients post-antireflux surgery or treatment for achalasia However, it's essential to note that esophageal manometry is not indicated for:
- Diagnosing or confirming gastroesophageal reflux disease
- Routine initial testing for chest pain or other esophageal symptoms due to the low specificity of findings, as outlined in the guidelines 1 The use of esophageal manometry should be guided by these recommendations to ensure appropriate utilization and maximize its benefits in patient care, particularly in diagnosing and managing motility disorders and other esophageal conditions 1.
From the Research
Indications of Esophageal Manometry
The following are indications for esophageal manometry:
- Dysphagia: a symptom commonly associated with esophageal motor disorders, which can be accurately defined and treated with the help of esophageal manometry 2, 3, 4, 5
- Chest pain: a symptom that can be related to esophageal motility disorders, and esophageal manometry can help identify abnormal motor function 2, 4
- Heartburn and regurgitation: symptoms that can be associated with esophageal motor disorders, and esophageal manometry can help establish a treatment plan based on motor abnormalities 2
- Achalasia: a condition characterized by the failure of the lower esophageal sphincter to relax, which can be diagnosed with the help of esophageal manometry 3, 6, 4, 5
- Scleroderma: a condition that can cause esophageal motility abnormalities, and esophageal manometry can help evaluate and characterize regional pressure and transit profile differences 6
- Hypercontractile motility disorders: conditions that can cause chest pain, heartburn, or dysphagia, and esophageal manometry can help diagnose and treat these disorders 4
- Opioid-induced esophageal dysmotility: a condition that can mimic symptoms of other motility disorders, and esophageal manometry can help confirm the diagnosis 4
Diagnostic Evaluation
Esophageal manometry is a crucial diagnostic tool for evaluating esophageal motility disorders, and it is often used in combination with other tests such as: