What does manometry evaluate? Well, the upper esophageal sphincter is certainly the gateway to the esophagus, and we can look to see what the resting pressure and the relaxation pressure are in that muscle. And why is that important? Well, if you've got someone who has atypical symptoms and they have a failure to relax their upper esophageal sphincter completely, that might indicate that we've got more of an oropharyngeal problem, such as cricopharyngeal achalasia or a cricopharyngeal bar, and they may be describing heartburn to you, but what they really have is burning in their throat, in their hypopharynx, because they're not able to clear very easily what they're doing. And their dysphagia that they may be presenting with is more oropharyngeal than it is esophageal. What else does manometry look at? It looks at esophageal contraction. We look whether it's present or absent. We look at its pattern. Is it ordered or disordered? We look at how quickly that propagation of the contraction wave works its way from the top to the bottom of the esophagus. Is it too fast, and therefore we get an inefficient emptying of the esophagus as a result? We look at the amplitude or strength of the swallow. Is it too weak to push the contents down where they need to be, below the lower esophageal sphincter and into the stomach? And then, of course, we can look at the LES as well. We're looking at the resting tone. Does it provide a good break wall to reflux? And the residual pressure during the swallow. Does it open up well enough to be able to let the contents through, or is this an esophageal outflow obstruction process that may be causing the symptoms with which the patient presents?

Manometry

upper esophageal sphincter

esophageal contraction

lower esophageal sphincter

oropharyngeal problems