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 is the ability of an organism to move independently using metabolism, metabolic energy. This biological concept encompasses movement at various levels, from whole organisms to cells and subcellular components.
Motility is observed in ...
or
peristalsis
Peristalsis ( , ) is a type of intestinal motility, characterized by symmetry in biology#Radial symmetry, radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an wikt:anterograde, anterograde dir ...
of the
esophagus
The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...
. These include
achalasia
Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esopha ...
,
diffuse esophageal spasm,
nutcracker esophagus
Nutcracker esophagus, jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by Peristalsis, contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive ...
and
hypertensive lower esophageal sphincter. These disorders typically present with
dysphagia
Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.
It may be a sensation that suggests difficulty in the passage of solids or l ...
, or difficulty swallowing, usually to both solids and liquids even initially. Other patients with
spasm
A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ, such as the bladder.
A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a musc ...
disorders may have the test done to diagnose
chest pain
Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...
thought not to be of
cardiac
The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissu ...
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 and
esophageal cancer
Esophageal cancer (American English) or oesophageal cancer (British English) is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include dysphagia, difficulty in swallowing and weigh ...
.
Procedure
A technician places a
catheter
In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...
into the nose and then guides it into the stomach. Once placed in the stomach lining, the catheter is slowly withdrawn, allowing it to detect pressure changes and to record information for later review. The patient will be asked at 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.
Other diagnostic tests for swallowing
Upper gastrointestinal series
An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as bariu ...
and their
fluoroscopic counterparts use
x-rays
An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...
to image the swallowing motions.
Recent advances
Recently,
high resolution manometry (HRM) has been developed that significantly reduces the procedure time (10 minutes versus 45 minutes with conventional manometry) and provides enhanced patient comfort. Newer catheters incorporate concurrent impedance with HRM.
See also
*
Esophageal motility disorder
*
Nutcracker esophagus
Nutcracker esophagus, jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by Peristalsis, contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive ...
*
Functional Lumen Imaging Probe
*
Anorectal manometry
Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and in ...
References
{{Digestive system procedures
Medical tests
Diagnostic gastroenterology
Digestive system procedures