The examination is performed by a physician with the assistance of a specially trained nurse. First, the nurse records your personal information into the device, reviews your preparation, and briefly explains the steps of the examination. The physician may then ask additional questions based on the referral and medical history.
Manometry cannot be performed under anesthesia, as your active participation is required during various stages. Sedatives are also avoided to prevent interference with esophageal motility. While not considered a pleasant examination, a Finnish study found that four out of five patients considered it less uncomfortable than gastroscopy.
Catheter placement
While seated, the physician inserts a semi-rigid catheter 3–4 mm in diameter through one of your nostrils. Before insertion, the nurse may lubricate your nostrils with oil drops. If the nostrils are very narrow, decongestant drops may be used. The catheter is treated with either lubricant or anesthetic gel—both are effective, but the lubricant has fewer side effects. Anesthetic spray may also be used, but it tastes unpleasant and inevitably flows into the throat. Nasal mucosa is sensitive, so irritation is difficult to avoid entirely. Occasionally, insertion or removal of the catheter may cause mild nosebleeds, which can be stopped by pinching the nose.
The tip of the catheter typically triggers a gag reflex in the lower throat. It is important not to panic at this stage and to follow the physician’s instructions carefully. By tucking your chin to your chest, the catheter is guided into the esophagus rather than the trachea. Swallowing small sips of water through a straw helps open the pathway to the esophagus. The physician then advances the catheter into the upper part of the stomach. The catheter is secured behind the head with a strap. The intensity and duration of throat irritation caused by the catheter vary. Some patients adapt immediately once the catheter is in place, while others experience nausea and gagging that subsides within a few minutes.
Measurement procedure
You will be asked to lie down for the measurement. The examination is usually performed in a supine position, but due to interference from heart rate and respiratory movements, a side position may sometimes be necessary. First, a baseline measurement is taken, during which a swallowing pause of 20–30 seconds calms the esophagus. Then, functional measurements begin, where you swallow a teaspoon of liquid (water or mild saline) from a syringe at least ten times. Finally, you sit up and drink a cup of liquid quickly. Additional measurements may be taken as needed, for example, while swallowing solid or liquid food.
The measurement typically lasts 10–15 minutes but may be significantly longer if, for example, strong gag reflexes interfere with the planned swallows. At the end, the nurse removes the catheter and the examination is complete. In some cases, the physician may provide an immediate preliminary assessment, but usually the measurement data must be analyzed further before results are available.
