Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Motility testing: When does it help?

INTRODUCTION

Routine motility tests such as esophageal manometry, gastric emptying, and anorectal manometry have become readily available. The wireless motility capsule is being increasingly utilized to assess whole gut transit as well as regional transit of the stomach, small bowel, and large bowel. However, the utility of these tests in clinical practice and their appropriate indications are incompletely understood.

This topic will review the indications for and utility of esophageal manometry, gastric emptying studies, and anorectal manometry. Specialized motility tests such as antroduodenal manometry, electrogastrography, and colonic manometry are under development and will not be discussed. Specific motility disorders are discussed elsewhere. (See "Distal esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter" and "Clinical manifestations and diagnosis of achalasia" and "Gastroparesis: Etiology, clinical manifestations, and diagnosis" and "Fecal incontinence in adults: Etiology and evaluation" and "Etiology and evaluation of chronic constipation in adults".)

The American Gastroenterological Association (AGA) guideline for the clinical use of esophageal manometry [1], as well as other AGA guidelines, can be accessed through the AGA web site at www.gastro.org/practice/medical-position-statements.

ESOPHAGEAL MANOMETRY

Esophageal manometry is most useful in evaluating patients with dysphagia, noncardiac chest pain, and prior to antireflux surgery. It may also be helpful for excluding generalized gastrointestinal (GI) tract disease such as scleroderma or chronic idiopathic intestinal pseudo-obstruction. (See "Overview of dysphagia in adults" and "Chest pain of esophageal origin" and "Surgical management of gastroesophageal reflux in adults" and "Overview of the clinical manifestations of systemic sclerosis (scleroderma) in adults", section on 'Gastrointestinal involvement' and "Chronic intestinal pseudo-obstruction".)

Technical aspects — The two manometric methods in use today are the low compliance water-perfused catheter system [2] and the solid-state pressure system [3]. Placement of the transducers, configuration, and recording must be done accurately to assure the reliability of the data. Both systems are acceptable methods of performing routine esophageal manometry, although each has its advantages. The introduction of high resolution manometry (HRM) may provide the potential for improvement in the diagnosis of various motility disorders [4]. The American Gastroenterological Association (AGA) technical review for the clinical use of esophageal manometry [5], as well as other AGA guidelines, can be accessed through the AGA web site at www.gastro.org/practice/medical-position-statements. (See "High resolution manometry".)

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Apr 14, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Pandolfino JE, Kahrilas PJ, American Gastroenterological Association. American Gastroenterological Association medical position statement: Clinical use of esophageal manometry. Gastroenterology 2005; 128:207.
  2. Arndorfer RC, Stef JJ, Dodds WJ, et al. Improved infusion system for intraluminal esophageal manometry. Gastroenterology 1977; 73:23.
  3. Vantrappen G, Janssens J. Manometric Techniques. In: Atlas of Gastrointestinal Motility in Health and Disease, Schuster M (Ed), Williams and Wilkins, Baltimore 1993. p.43.
  4. ASGE Technology Committee, Wang A, Pleskow DK, et al. Esophageal function testing. Gastrointest Endosc 2012; 76:231.
  5. Pandolfino JE, Kahrilas PJ, American Gastroenterological Association. AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005; 128:209.
  6. Ghosh SK, Pandolfino JE, Zhang Q, et al. Quantifying esophageal peristalsis with high-resolution manometry: a study of 75 asymptomatic volunteers. Am J Physiol Gastrointest Liver Physiol 2006; 290:G988.
  7. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology 2008; 135:756.
  8. Katz PO, Dalton CB, Richter JE, et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients. Ann Intern Med 1987; 106:593.
  9. Reidel WL, Clouse RE. Variations in clinical presentation of patients with esophageal contraction abnormalities. Dig Dis Sci 1985; 30:1065.
  10. Achem SR, Crittenden J, Kolts B, Burton L. Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders. Am J Gastroenterol 1992; 87:825.
  11. Swift GL, Alban-Davies H, McKirdy H, et al. A long-term clinical review of patients with oesophageal pain. Q J Med 1991; 81:937.
  12. Ott DJ, Richter JE, Chen YM, et al. Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol 1987; 149:307.
  13. Kahrilas PJ, Dodds WJ, Hogan WJ, et al. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 1986; 91:897.
  14. Fibbe C, Layer P, Keller J, et al. Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology 2001; 121:5.
  15. Castell DO. Esophageal manometry prior to antireflux surgery: required, preferred, or even needed? Gastroenterology 2001; 121:214.
  16. Lund RJ, Wetcher GJ, Raiser F, et al. Laparoscopic Toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility. J Gastrointest Surg 1997; 1:301.
  17. Mughal MM, Bancewicz J, Marples M. Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication. Br J Surg 1990; 77:43.
  18. Heider TR, Behrns KE, Koruda MJ, et al. Fundoplication improves disordered esophageal motility. J Gastrointest Surg 2003; 7:159.
  19. Rodnan GP. Dr. J. Claude Bennett to assume editorship. Arthritis Rheum 1975; 18:631.
  20. Camilleri M, Hasler WL, Parkman HP, et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998; 115:747.
  21. Parkman HP, Hutson A, Sarosiek I, et al. SmartPill capsule for assessment of gastric emptying: Comparison with simultaneous gastric emptying scintigraphy (abstract). Am J Gastroenterol 2006; 101(Suppl):S99.
  22. Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther 2008; 27:186.
  23. Cassilly D, Kantor S, Knight LC, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil 2008; 20:311.
  24. Camilleri M, Thorne NK, Ringel Y, et al. Wireless pH-motility capsule for colonic transit: prospective comparison with radiopaque markers in chronic constipation. Neurogastroenterol Motil 2010; 22:874.
  25. Rao SS, Kuo B, McCallum RW, et al. Investigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation. Clin Gastroenterol Hepatol 2009; 7:537.
  26. Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci 2009; 54:2167.
  27. Rao SS, Camilleri M, Hasler WL, et al. Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil 2011; 23:8.
  28. Kloetzer L, Chey WD, McCallum RW, et al. Motility of the antroduodenum in healthy and gastroparetics characterized by wireless motility capsule. Neurogastroenterol Motil 2010; 22:527.
  29. Wald A. Colonic and anorectal motility testing in clinical practice. Am J Gastroenterol 1994; 89:2109.
  30. Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 1997; 92:469.
  31. Noelting J, Ratuapli SK, Bharucha AE, et al. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 2012; 107:1530.
  32. Glia A, Gylin M, Akerlund JE, et al. Biofeedback training in patients with fecal incontinence. Dis Colon Rectum 1998; 41:359.
  33. Wald A. Anorectum. In: Atlas of Gastrointestinal Motility in Health and Disease, Schuster M (Ed), Williams and Wilkins, Baltimore 1993. p.229.
  34. Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med 1992; 326:1002.
  35. Mitrani C, Chun A, Desautels S, Wald A. Anorectal manometric characteristics in men and women with idiopathic fecal incontinence. J Clin Gastroenterol 1998; 26:175.
  36. Sentovich SM, Blatchford GJ, Rivela LJ, et al. Diagnosing anal sphincter injury with transanal ultrasound and manometry. Dis Colon Rectum 1997; 40:1430.
  37. Camilleri M, Thompson WG, Fleshman JW, Pemberton JH. Clinical management of intractable constipation. Ann Intern Med 1994; 121:520.
  38. Papachrysostomou M, Smith AN. Effects of biofeedback on obstructive defecation--reconditioning of the defecation reflex? Gut 1994; 35:252.
  39. Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998; 93:1042.
  40. Minguez M, Herreros B, Sanchiz V, et al. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 2004; 126:57.
  41. Osatakul S, Patrapinyokul S, Osatakul N. The diagnostic value of anorectal manometry as a screening test for Hirschsprung's disease. J Med Assoc Thai 1999; 82:1100.
  42. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787.
  43. Rao SS, Welcher KD, Pelsang RE. Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci 1997; 42:2197.
  44. Heymen S, Jones KR, Scarlett Y, Whitehead WE. Biofeedback treatment of constipation: a critical review. Dis Colon Rectum 2003; 46:1208.
  45. Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 2006; 130:657.
  46. Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol 2007; 5:331.
  47. Heymen S, Scarlett Y, Jones K, et al. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum 2007; 50:428.
  48. Chiarioni G, Salandini L, Whitehead WE. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology 2005; 129:86.