Motility testing: When does it help?
- Anthony J Lembo, MD
Anthony J Lembo, MD
- Associate Professor of Medicine
- Harvard Medical School
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 "Esophageal motility disorders: Clinical manifestations, diagnosis, and management" and "Achalasia: Pathogenesis, clinical manifestations, and diagnosis" and "Gastroparesis: Etiology, clinical manifestations, and diagnosis" and "Fecal incontinence in adults: Etiology and evaluation" and "Etiology and evaluation of chronic constipation in adults".)
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 "Evaluation of the adult with 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  and the solid-state pressure system . 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 . (See "High resolution manometry".)
●The water-perfused system has the advantage of being relatively durable and inexpensive. Its disadvantages include the need for skilled personnel in its maintenance and use, and its inability to accurately record pharyngeal pressures.
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- ESOPHAGEAL MANOMETRY
- Technical aspects
- Gastroesophageal reflux disease
- - Prior to antireflux surgery
- Noncardiac chest pain
- Multisystem diseases
- GASTRIC EMPTYING
- Wireless motility capsule
- ANORECTAL MANOMETRY
- Fecal incontinence
- - Biofeedback
- - Pelvic floor dyssynergia
- - Reduced rectal sensation
- - Hirschsprung disease
- - Biofeedback
- SUMMARY AND RECOMMENDATIONS