Functional diagnostics in the MCSC: esophageal manometry

News 02/19/2020

Modern man is increasingly faced with diseases of the esophagus. This is due to high levels of stress, poor nutrition and abuse of bad habits. Some diseases are asymptomatic, while others, on the contrary, cause a person discomfort.

What are the symptoms of the disease noted by patients? Most often, they complain about:

• problems with swallowing when eating (dysphagia);
• chest pain.

Dysphagia can occur with prolonged gastroesophageal reflux disease (BBD). In other cases, its presence should alert the patient and the doctor, as this is a symptom of a violation of the motor function of the esophagus or a neoplasm in it.

People with complaints of pain behind the sternum first undergo additional examinations to exclude other causes of pain, namely:

• coronary heart disease;
• thoracoalgia;
• acute pneumonia;
• pleurisy;
• TELA;
• chest injuries.

If the cause has not been established, the patient comes to the gastroenterologist for further examination and detection of pathology. He prescribes a number of important tests: esophagogastroduodenoscopy( EGDS), X-ray and esophageal manometry.

Esophageal manometry is an instrumental method of studying the motility of the esophagus, which allows you to track the work of contraction and relaxation of its muscles. It allows specialists to identify diseases of the esophagus: achalasia, diffuse esophagospasm, scleroderma.

Indications and contraindications

Esophageal manometry is used for:

• complaints about difficulty passing food;
• complaints of chest pain not related to heart disease;
• clarification of the type of achalasia and selection of the type of surgical intervention.
• exclusion of contraindications in operations for hernia of the esophageal opening diffragma;
• clarification of the level of the lower esophageal sphincter before other functional studies of the gastrointestinal tract. 

Esophageal manometry is not prescribed for:

• malignant neoplasms of the pharynx, larynx, esophagus, stomach, preventing the introduction of the probe;
• varicose veins larger than 5 mm;
• ulcers of the esophagus and stomach with the threat of bleeding;
• burns, diverticula, esophageal constriction;
• severe blood clotting disorders;
• mental illness;
• severe forms of coronary heart disease.

It is mandatory to have an EGDS protocol to exclude contraindications.

Preparation for the procedure

On the eve of the procedure, the patient should not take food or any kind of liquid later than 12 o'clock in the morning. Subjects with suspected esophageal achalasia can withstand 12 hours of fasting, and for 3 days before the study can only take liquid food.

For 3 days, you should refuse to take the following medications:

• regulating the motility of the digestive tract (domperidone, itoprid, metoclopramide);
• relieving pain caused by muscle spasm (hyoscine butyl bromide, drotaverine);
• eufillin and theophylline;
• for the relief of angina attacks (nitrates).

If the patient suffers from hypertension, he must take antihypertensive drugs before the procedure for 1-2 hours. 

Methodology

Before starting the study, a 4 mm diameter probe is inserted through the nasal passage through the esophagus into the stomach in a sitting position.  For a more comfortable promotion of the tube, a local anesthetic – lidocaine-is used. It is applied to the nasal mucosa.

After installing the probe, the person assumes a horizontal position. The tube is connected to a device that records the contraction of the esophageal muscles. To assess peristalsis, a standard sip of 5 ml of water in an amount of 10 times is used. During the procedure, you need to breathe calmly and try not to cough.

The doctor evaluates the data obtained in the study and gives the result to the patient on the same day.