Oesophageal Manometry & 24-Hour pH Testing

The healthy functioning of the oesophagus is relatively complicated. There are bands of muscle, ‘sphincters’, at the top and bottom of the oesophagus, as well as nerves and muscles running the entire length of the oesophagus. These nerves and muscles all need to work together in a coordinated way for swallowing to be effective. Conditions of a neurological or muscular nature can impair this normal functioning and result in swallowing problems or secondary oesophageal reflux.

These tests provide your physician with important information regarding how well the oesophagus contracts to move food and fluid down, and how much acid is coming back up so in order to determine the best treatment for your condition.

What Is Oesophageal Manometry?

Difficulty swallowing (‘dysphagia‘) is very common. Once a structural problem has been ruled out, the next step is diagnosing a problem is through an oesophageal manometry.

Oesophageal manometry measures the pressures in the oesophagus when food is being squeezed down. It tests the strength and coordination of peristalsis of the oesophagus as well as the function of both the upper and lower oesophageal sphincters. 

The Procedure

The test is performed at the clinic and requires no preparation. Important steps include:

  • A local anaesthetic (lidocaine) is sprayed through the nose and at the back of the throat to numb the area for maximum comfort
  • A tiny catheter is then passed through the nose and back of the mouth into the oesophagus. While this may be uncomfortable, this lasts for a few short moments. Once the catheter is inside the oesophagus, there is minimal discomfort.
  • Oesophagus measurements are then taken while at rest and when swallowing. A total of ten swallowing measurements will be taken before removing the catheter.
  • The procedure lasts 5- 10 minutes.

Data is then collected and applied to standardized criteria to make the help make the right diagnosis.

What Is 24hr pH Testing?

Oesophageal 24-hour pH measures how much reflux (acidic or non-acidic) in your oesophagus over a 24-hour period. This helps determine whether reflux of stomach contents into the oesophagus is causing symptoms such as regurgitation, heartburn, cough or sore throat. This test can be useful in several scenarios, including:
  • Atypical symptoms such as chest pain that may or may not be associated with acid reflux
  • Classic heartburn symptoms that poorly respond to treatment
  • For those seeking to safely wean off anti-acid medications 

The Procedure

This test will involve placing a catheter through your nasal passage, and then swallowing it into your oesophagus with water. You will have no trouble swallowing, talking, or breathing during the procedure. An alternative to the catheter is the Bravo capsule. This small capsule is placed in the oesophagus with a gastroscope to measure oesophageal pH for a period of 96 hours. The Bravo system is much more comfortable than the catheter and provides more comprehensive data.