Esophageal Manometry

Updated: Jun 14, 2022
  • Author: Philip O Katz, MD, FACP, FACG; Chief Editor: Kurt E Roberts, MD  more...
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Esophageal manometry measures the different factors that play a role in the motility and function of the upper esophageal sphincter (UES), the body of the esophagus, and the lower esophageal sphincter (LES). [1, 2]

The esophagus can be affected by a variety of disorders that may be intrinsic or secondary to another pathologic process, but the resulting symptoms are usually not pathognomonic for a specific problem, making diagnosis somewhat challenging.

Although detailed history taking, review of symptoms, and physical examination can orient the clinician in the right direction, further tests, including esophageal manometry, are sometimes necessary for establishing a diagnosis. The first attempts to test esophageal function date back to 1883, [3, 4]  but the technology that would allow a proper recording of esophageal pressure dynamics was not developed until the 1970s.



Esophageal manometry is indicated for the following situations:

  • Evaluation of noncardiac chest pain or esophageal symptoms not diagnosed by endoscopy (or after  gastroesophageal reflux disease [GERD] has been excluded)
  • Evaluation for  achalasia [5]  or another type of nonobstructive  dysphagia
  • Preoperative evaluation for patients undergoing corrective surgery for GERD, particularly if an alternative diagnosis like  scleroderma or achalasia is being considered [6]
  • Postoperative evaluation of dysphagia in patients who underwent corrective surgery for reflux or after treatment of achalasia
  • Prior to esophageal pH monitoring to assess the location of the LES for proper electrode positioning
  • Evaluation of esophageal motility problems associated with systemic diseases

According to the Lyon Consensus, [7] high-resolution manometry (HRM) is not useful for the direct diagnosis of GERD but can be useful in the setting of GERD by providing adjunctive information (eg, on esophagogastric junction [EGJ] barrier function, esophageal body motor function, contractile function, or EGJ obstruction). American College of Gastroenterology (ACG) guidelines do not recommend HRM solely as a diagnostic test for GERD. [6]

A study of patients who underwent protocolized videoesophagography (VEG) and manometry in preparation for foregut surgery found that routine manometry was not warranted in patients with normal VEG and suggested that it should be reserved for patients with abnormal VEG. [8]



Esophageal manometry is contraindicated in the following situations:

  • Patients with altered mental status or obtundation
  • Patients who cannot understand or follow instructions
  • Suspected or known pharyngeal or upper esophageal obstruction (eg, tumors)

Technical Considerations

Procedural planning

Some conditions can lead to technical difficulties when performing esophageal manometry, such as achalasia, large hiatal hernias, intrathoracic stomach, and patients with prior esophageal surgery, among others. Knowledge about these conditions can help the technician prepare beforehand for difficulties that may arise. A variety of problems can affect the esophagus and produce multiple symptoms; this can give some insight into what the diagnosis may be and how to tailor the procedure to the suspected affected area.

Complication prevention

If one encounters problems or resistance that cannot be overcome with reasonable pressure while trying to pass the manometry catheter through the nostrils (particularly in patients with prior nasal surgery, deformation, or small nares), the catheter can instead be introduced through the mouth. This will avoid lesions caused by forcing the catheter against resistance.