February 2, 2017

If you ever ever hear these words used relative to an investigation your doctor wants you undertake—RUN AWAY.  I say this advisedly because I just experienced this test due to issues I was and am having with acid reflux.  The first test was a barium swallow with pill.  This was not so bad and took a fairly short period of time. The motility test is definitely a horse of a different color.  Let’s examine the motility test and take a look at what all is involved.

ESOPHAGEAL MOTILITY:  We start first with a definition as follows:

An esophageal motility disorder is any medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. The most prominent one is dysphagia.  Dysphagia is the medical term used to describe difficulty swallowing. … In contrast, dysphagia is a symptom that only occurs when attempting to swallow. Globus can sometimes be seen in acid reflux disease, but more often, it is due to increased sensitivity in the throat or esophagus. There are several very popular over-the-counter medication to mitigate acid reflux.  Just a few are. 1.) TUMS, 2.) Alka-Seltzer, 3.) Milk of Magnesia, 4.) Pepto-Bismol, 5.) ZANTAC, 6.) Pepcid, 7.) Tagamet, and 8.) Prilosec OTC.  These medications work and work well but I really wanted to get an answer as to WHY I was having the reflux.  For this, testing was necessary.

The tubular esophagus is a muscular organ, approximately 25 cm in length, and has specialized sphincters at proximal and distal ends. (That upper and lower portions of the esophagus.) The upper esophageal sphincter (UES) is comprised of several striated muscles, creating a tonically closed valve and preventing air from entering into the gastrointestinal tract. The lower esophageal sphincter (LES) is composed entirely of smooth muscle and maintains a steady baseline tone to prevent gastric reflux into the esophagus.

Esophageal motility disorders are less common than mechanical and inflammatory diseases affecting the esophagus, such as reflux esophagitis, peptic strictures, and mucosal rings. The clinical presentation of a motility disorder is varied, but, classically, dysphagia and chest pain are reported. This was my case, chest pain accompanied with reflux after every meal. Before entertaining a diagnosis of a motility disorder, first and foremost, the physician must evaluate for a mechanical obstructing lesion. This is the motility test.

THE PROCEDURE: The procedure takes about forty-five (45) minutes from start to finish.  Please note, the patient, in this case ME, is fully awake so commands may be received and followed.

  • The nurse will verify that you had nothing by mouth in the last 6 hours prior to the test. It is a fasting test.  I also took none of the medications I normally take A.M. This is very important.
  • Your nostril and throat is numbed with a topical anesthetic while you are sitting upright. This topical anesthetic BURNS LIKE HELL and gives the sensation your nostril is stopped up. It actually is I suppose.
  • A thin flexible tube about one-eighth inch in diameter (approximately the size of pencil) is then passed through the nostril, down the back of the throat into the esophagus and the stomach, while the patient swallows water.  (Are you getting this?)  The nurse snakes a tube with thirty-six (36) pressure-sensing rings or holes through your nose and down your throat right into the upper portion of your stomach. OH by the way—you feel it all the way down!
  • The tube has holes in it that sense pressure along the esophagus. It will be positioned in different areas of your esophagus. The nurse moves the tube as the test progresses.
  • With the tube inside the esophagus, you will lie down on your left side.  This is to prevent ingesting bile and aspirating that into your lungs if it does occur.  (Now do I have your attention?)
  • The nurse will give you small sips of water during the test to record the progression of the swallow.  Each sip is metered and measured using a syringe. Five Ml, ten Ml, etc etc.
  • The contractions of the esophageal muscle will be measured at rest and during swallows.
  • Pressure recordings are made while the tube is in place and as the tube is slowly withdrawn.
  • The results of the manometry test are displayed as a graph with a wave pattern that can be interpreted to determine if the esophagus is functioning normally.  The digital image on the left below will indicate the location of the tube and on the right, the pressure spikes as you swallow. During the test, I started coughing and had difficulties in calming down.  With each cough, the tube would rattle around and bounce right and left hitting the walls of my esophagus.  Really great feeling.
  • Since your throat was numbed, you have to wait one hour after completion of the test before you can eat or drink anything. This is to protect you from burning your throat or choking.


The actual display on the monitor looks like the images below.  Again, location on the left and pressure on the right.


I will certainly say this; the nurse was very patient with me as the tube was inserted and withdrawn.  The insertion feels like someone trying to slip a garden hose through the eye of a needle. One of the most uncomfortable feelings I have ever had. I am told some patients simply cannot tolerate the test and have to bail out.  It really was a struggle for me but I decided I needed an answer more than I needed immediate relief.

The technology monitoring the pressure is fabulous and very accurate.  As it turns out, my problem seems to be with the lower sphincter valve. It does not close tightly enough to prevent acid reflux.  I have no idea as to what the “fix” might be.  I find that out on 14 February.  I suppose that information will be my Valentine’s Day present.  I can promise you two things: 1.) Ain’t no way I’m repeating the test—ever and 2.) if I have to live on Prilosec for the rest of my life I will.  No surgery.

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