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Diagnose Reflux Using Esophageal Manometry

Esophageal manometry is a very common test that’s performed when we evaluate patients who have refractory reflux. It really is important because sometimes the lower esophageal sphincter is actually too tight rather than too loose. This would be known as achalasia. In upwards of between five and 15% of patients who have classic reflux symptoms, they may really have achalasia, which is the sphincter being too tight.  In this case that would be treated in a completely different way because it’s not reflux. What we’re looking for in the non-achalasia patient, the standard refluxing patient, is how high is the pressure at the lower esophageal sphincter and that is a reflection of how little or how much muscle you may still have to resist the gastric pressure in order to not reflux.

We get this information from the manometry study. We also get information about the upper esophageal sphincter. Often people with reflux have an overly tight upper esophageal sphincter as a reaction to protect the larynx against reflux. The other component we look at is the actual peristalsis, or normal contraction in a rhythmic fashion from top to bottom of the esophagus. The disorder of peristalsis, which is reflected as a percentage of normal verus spasm versus just simply non-conducted contractions becomes very important because it reveals the severity of the damage caused by the reflux and how much the reflux has adversely affected the esophagus.

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