Drs K Bodger and NJ Trudgill
In patients with suspected oesophageal symptoms, flexible endoscopy and/or contrast radiology (eg. barium swallow) should be performed before considering manometric assessment.
Oesophageal manometry is indicated for the evaluation of dysphagia not definitively diagnosed by means of endoscopy and/or radiology, as manometry is the most accurate method for diagnosing the well-characterised primary oesophageal motility disorders (achalasia and diffuse oesophageal spasm). Oesophageal manometry is the most accurate method for pH electrode placement.
Acid gastro-oesophageal reflux accounts for a significant proportion of non-specific manometric abnormalities and a therapeutic trial of a proton pump inhibitor is recommended in the initial management of patients with suspected oesophageal symptoms, who have non-specific motility abnormalities identified at manometry.
Pre-operative oesophageal manometry is of limited value but does prevent anti-reflux surgery in the rare patients who present with clinical features suggestive of acid gastrooesophageal reflux and have a primary motility disorder, such as achalasia, and is therefore recommended.