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Overview of gastrointestinal motility testing

Author
Anthony J Lembo, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Disorders of gastrointestinal (GI) transit and motility are common, and can affect one or more regions of the GI tract [1]. This topic will review the indications, technique, and interpretation of the results for commonly performed tests to evaluate GI tract motility. Specific motility disorders are discussed in detail 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 "Chronic intestinal pseudo-obstruction" and "Etiology and evaluation of chronic constipation in adults" and "Fecal incontinence in adults: Etiology and evaluation".)

ESOPHAGUS

Esophageal manometry — Esophageal manometry assesses intraluminal esophageal pressures, peristalsis, and bolus transit.

Indications

Dysphagia — In patients with esophageal dysphagia in whom upper endoscopy is unrevealing, esophageal manometry can diagnose an underlying esophageal motility disorder [2]. In patients with oropharyngeal dysphagia of unclear etiology, manometry helps to determine the underlying cause and can identify patients with oropharyngeal dysphagia who may benefit from surgical myotomy. (See "Overview of dysphagia in adults", section on 'Diagnostic testing' and "Oropharyngeal dysphagia: Clinical features, diagnosis, and management".)

Gastroesophageal reflux disease management — The most important role of esophageal manometry in patients with gastroesophageal reflux disease (GERD) is prior to antireflux surgery. Manometry serves to exclude an alternative diagnoses, such as scleroderma or achalasia, for which antireflux surgery may be contraindicated. In addition, manometry may lead to a modification of the surgical approach or a change in management; however, this is controversial. Esophageal manometry is not diagnostic for GERD and manometry cannot predict disease severity [3]. Non-specific manometric findings that may be seen in patients with GERD include impaired peristalsis, decreased peristaltic amplitude, hypotensive lower esophageal sphincter, and excessive transient relaxations. (See "Clinical manifestations and diagnosis of gastroesophageal reflux in adults", section on 'Esophageal manometry' and "Surgical management of gastroesophageal reflux in adults".)

Noncardiac chest pain — GERD is the most common cause of noncardiac chest pain. Esophageal manometry should be performed to exclude an esophageal motility disorder in patients who fail to respond to eight weeks of proton pump inhibitor therapy for empiric treatment of GERD. (See "Evaluation of the adult with chest pain of esophageal origin", section on 'Diagnostic strategies and initial management'.)

                        

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 12 00:00:00 GMT 2016.
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