manometry
Posted , 7 users are following.
Has anyone had a manometry recently?, I'm due for one and I don't have a clue what to look forward to, is it very painful? would really like to hear your opinions. Pam
1 like, 12 replies
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Notes on manometry
moonbuggy explayboybunny
Posted
It isn't painful. It isn't very pleasant though. It does become more bearable after a few hours. I found that any sudden head movements/turning is best avoided. Sleeping was difficult also.
I probably shouldn't reply to your posts as you must think I am very negative
Reflux is not a pleasant condition
explayboybunny moonbuggy
Posted
Many thanks
Pam
wknight explayboybunny
Posted
i have also had the tube down the nose job and that isn't pleasant and you do have to watch what you eat as some food can catch on the tube.
Glennie68 explayboybunny
Posted
I had my manometry done in November, it's not as bad as an endoscopy, they make you drink water through a straw as they feed the tube down, if you concentrate on that - it's not as bad as sounds. It is uncomfortable, the manometry cathater is a little bit thicker than the one they do the 24 hour ph test with, but as they take measurements with the 1st test, the second catheter is much easier and quicker to place. It does tug when you eat certain foods, but without the tests done they won't operate. It's 24 hours and you won't get a lot of sleep - but it's worth it to get better!
Good luck and let me know how it goes.
nfa explayboybunny
Posted
Some replies are slightly mixing up "manometry" and "pH monitoring", although they are linked.
Manometry is done first. It measures peristalsis in the oesophagus, and also the co-ordination and pressure forces exerted by the muscles in the oesophagus. It also measures the pressure in the lower oesophageal sphincter (valve between stomach and oesophagus). It can also show if a hiatus hernia is present, more reliably than endoscopy.
Manometry lasts about 20 minutes, and involves a tube down the nose into the oesophagus to a point just above the lower oesophageal sphincter. You will be required to take about ten swallows of water so the pressure the oesophagus uses to swallow those drinks can be measured.
It is a rather uncomfortable procedure, depending a bit on your own tolerance of the tube down your throat! However, it does not last long.
The GI physiologists also use having the manometry tube in to identify where to place the sensor, just above the lower oesophageal sphincter, for the 24 hour pH monitoring tube.
The 24 hour pH monitoring tube, also down the nose into the oesophagus, is somewhat thinner than the tube they use for manometry. I found it easier to have inserted and tolerate for the 24 hour test, than the manometry tube. Again, I suspect individual tolerance varies. It can be rather embarrassing having the tube taped to the nose and side of the face. You might want to make sure you have a hoodie, or a scarf for travelling from the hospital back to your home. However, some people seemed fine about it showing, and why not!
24 hour pH monitoring with the naso-gastric tube down the nose and throat does enable "non-acidic" reflux (pepsin/bile etc.,) to be detected, whereas the 48 hour BRAVO does not. That only detects gastric acid.
BRAVO also involves having another endoscopy to fit the capsule to the side of the oesophagus. It does test for longer, and some centres do the test for up to 96 hours, though 48 hours in the usual time. The BRAVO can be useful if the 24 hour "tube" test has shown "normal" results, but there is suspicion that there IS acid reflux which has not been found during that 24 hour test period.
So no, neither procedure is painful, but certainly pretty uncomfortable, and I felt embarrassed by the tube taped to my face! I was a bit aware of the tube "pulling" a bit in my nose and oesophagus, but nothing painful or awful.
The information the tests give is extremely helpful, and essential if surgery is a possibility, so I guess we just have to put up with these unpleasant procedures!
Hope my comments will help, and not just make you more worried.
Don't hesitate to ask if anything I have said is confusing, or if you want to ask me more about anything.
explayboybunny nfa
Posted
1diamond_owl nfa
Posted
Thank you for the in-depth information.If I may ask who are the candidates for all these procedures.?If you have Gerd issues, burping and Globus sensation are you reuired to have all the above procedures.,and can these be done under sedation.? I had an endoscopy for so many years and I didn't feel any pain or discomfort at all.
Thank you very much.
nfa 1diamond_owl
Posted
I gather the main reason for the procedures is for a clearer diagnosis between things like "Functional Reflux"; "Pathological Reflux", and therefore true GERD.
Manometry helps to determine the extent of any loss of pressure in the lower oesophageal sphincter, and of any loss of contraction in the oesophagus. That information is quite important if any of the anti-reflux surgeries are being considered, such as LINX or Fundoplication "wraps".
For example, I believe that LINX is contraindicated if the potential patient has reduced motility/peristalsis of the oesophagus, as one has to be able to swallow quite hard to get food through the titanium "bracelet" that is placed around the lower oesophagus.
I doubt that these tests would be required as such. I think you will find that most doctors will do a trial treatment on proton pumps inhibitors for the symptoms you mention, and probably only refer for further tests such as manometry/ pH monitoring if the patient does not get enough symptom relief.
I doubt that the manometry test could be done under sedation, as one has to do about ten small swallows whilst the tube is in your throat so the GI physiologist can measure the pressure in your oesophagus. You would be unable to comply with that if you were sedated.
They tend to then fit the thinner tube for the 24 hour pH monitor immediately after the manometry test, and the GI physiology departments are just not geared to offering sedation for that procedure, as that would have to be monitored, and would require extra staff.
The longer acid monitoring of the 48 hour BRAVO test IS done under sedation, as it requires an endoscopy to place the monitoring capsule in your oesophagus. However, not that many NHS hospitals do that procedure as yet. If you can find a centre that does BRAVO I would have thought it should be possible to get referred to such a centre, even if they just report back their results to your original gastroenterologist, who would then continue your care.
You can see video films of these procedures if you do a search in your search engine along the lines of: "Youtube videos of manometry" or "24 hour pH monitoring".
Like you, with all but one of the four endoscopies I have had, so far, I have been totally sedated and felt no pain or discomfort, or gagging.
Hope this reply answers your questions?
1diamond_owl nfa
Posted
AmandaFA explayboybunny
Posted
Many thanks for asking this question as I may need to have one fo these done soon too and would like to know what to expect.
Amanda.
nfa explayboybunny
Posted
I am so sorry to hear what a rough time you have had.
To answer you question, the problem is that pain/discomfort is such a subjective thing, and what is a doddle to one, can be extremely unpleasant to another.
With the manometry I found the sense of gagging awful. However, by breathing carefully with deep breaths and relaxation techniques I managed it. I am not meaning to be a nitpicker, but I found the procedure uncomfortable due to some gagging and slight choking sensation, but not painful. I have had a rough time with a colonoscopy too, and found that painful AND uncomfortable!
I was so sorry to hear you had a tough time with endoscopy too. Did you have sedation? It should be a painless procedure, but I know some centres do not offer sedation at all, or there may have been some reason you did not want sedation?
That said, manometry is not (in my experience) as bad as endoscoopy as far as the tube insertion goes. I did have some gagging during my first endoscopy as they put the tube in (because the doctor had not waited for the sedation to "kick in". It then did, and I have no further memory until I work up. Two subsequent endoscopies with really good doctors where effortless as they waited for the sedation to work.)
Once the manometry tube was removed, I found the insertion of the secod tube for the pH monitoring was much easier, as it is much thinner, and caused no gagging, just a tickle as it went in.
The actual experience of having the tube in for 24 hours was never more than just being aware of a slight "tugging" as you would expect with a tube into your nose, but no actual pain.
The slight problem for you is that I can not see how they could do manometry under sedation as you need to "swallow" many times when they ask you to. Also, you will need the manometry and 24 hour pH results for any surgeon to give you an opinion as to whether they think there is a case for surgery,
Although this would not get past the problem of the manometry test, do you know if where you are attending do the 48 hour BRAVO pH monitor? Though, of course, that would mean another endoscopy to place the capsule, and that would be another hurdle, especially if your service does not offer sedation.
I do not know how comfortable you are with "stating your case", but if you can,(or ask a friend to) I would tell the GI physiologist (who does the manomentry and 24 hour pH monitor) that you may not be able to tolerate the procedure, but see how you go. I know they are used to some people finding the procedures harder than others.
If you find you can not cope, you could then ask your centre and/or GP if they could refer you to a centre that does BRAVO 48 hour pH monitoring. (under sedation). However, I think you really will need the manometry results, so try to give it a go.
Best wishes
nfa explayboybunny
Posted
Another suggestion. Hoping this does not make you more worried, but there are some films on youtube of what happens at a manometry and pH monitor tube insertion.
If you put "youtube videos of manometry" into whatever search engine you use, you will find a number of little films showing the procedure.
Hope this helps!