The study of pressure patterns and related measurements to assess the (dys)function of the gastro-intestinal tract. Static oesophageal manometry and ambulatory pH and/or motility studies can be performed to aid the diagnosis and management of patients presenting with gastroesophageal reflux disease, swallowing disorders, unexplained chest pain, regurgitation and persistent cough.
Ano-rectal manometry can be performed to evaluate pressures and physiological responses in the anal canal and rectum to aid the diagnosis and management of patients presenting with incontinence or constipation. It can also be useful for pre-operative evaluation of ano-rectal function prior to surgical procedures such as sphincterotomy, ileo-anal pouch, reversal of colostomy etc.
Some of the common study types are:
Ambulatory pH Monitoring
24 hour ambulatory pH monitoring is performed to determine the amount of time that the oesophagus is exposed to gastric acid. A catheter mounted pH sensor is positioned 5cm above the proximal margin of the lower oesophageal sphincter, and event markers (erect, supine, meal, pain etc.) are recorded to allow assessment of any possible association with acid reflux.
Analysis of the frequency and duration of pH episodes below a critical threshold of pH4 allow an estimation of the patient's typical acid exposure, and any association with the events recorded may help in the diagnosis.
24hour ambulatory pH studies are the only way to quantify abnormal oesophageal acid exposure and confirm the diagnosis of Gastro-Oesophageal Reflux Disease.
Clinical applications:
For the definitive diagnosis of gastro-oesophageal reflux in patients whose symptoms have warranted endoscopy, but whose endoscopy is normal.
To investigate the possibility of gastro-oesophageal reflux as a cause of chest-pain, respiratory and laryngeal symptoms, in whom the relevant investigations have been normal, and to correlate such symptoms with reflux episodes.
When established gastro-oesophageal reflux responds poorly to optimal medical therapy, and particularly when surgical treatment is being contemplated.
Before and after anti-reflux surgery
Oesophageal Manometry
Oesophageal manometry is a non-radiological method of assessing oesophageal 'motility'. It provides a method of characterising the pattern of motility throughout the oesophagus and its sphincters, using pressure recordings obtained from a multi-lumen catheter.
Clinical applications:
Evaluation of unexplained Dysphagia
Evaluation of atypical chest pain
Pre and post-surgical assessment of peristalsis
Accurate placement of pH electrodes for ambulatory monitoring
Lower Oesophageal Sphincter Function
Oesophageal Body Motility
Ano-rectal Manometry
Rectal manometry is performed to evaluate physiological responses in the anal canal and rectum for the assessment and diagnosis of incontinence and constipation. Microtip or water-perfused catheters may be used.
Clinical applications:
Faecal Incontinence
Constipation
Pelvic Floor Dyssynergia
Hirschsprung's Disease
Pre-operative evaluation of ano-rectal function prior to surgical procedures such as sphincterotomy, ileo-anal pouch, reversal of colostomy etc.
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